Remnant preserving ACL reconstruction with a functional remnant is related to improved laxity but not to improved clinical outcomes in comparison to a nonfunctional remnant

Franciozi, Carlos Eduardo da Silveira; Minami, Flávio Kazuo; Ambra, Luiz Felipe; Galvão, Pedro Henrique Schmidt Alves Ferreira; Schumacher, Felipe Conrado; Kubota, Marcelo Seiji

doi:10.1007/s00167-021-06572-1

Cited by 13 publications

(17 citation statements)

References 70 publications

(171 reference statements)

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“…The results showed that preservation without remnant tensioning had significant advantages in terms of Lysholm score, IKDC grade, Pivot-shift test and side-to-side difference, but group preservation with remnant tensioning does not show the significant superiority, comparing to Group ACLR-S. The results may be due to the points mentioned above, the differences in ACLR procedures, remnant placement, and amount and quality of remnant preservation ( 33 , 40 , 48 , 49 ).…”

Section: Discussionmentioning

confidence: 94%

Effects of remnant preservation in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

Xie

Zhong

et al. 2022

Front. Surg.

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BackgroundCompared with standard anterior cruciate ligament (ACL) reconstruction, it is controversial whether anterior cruciate ligament reconstruction (ACLR) with remnant preservation can lead to better clinical outcomes. We conducted a systematic study and meta-analysis to assess the differences in clinical efficacy between the two.MethodWe searched for clinical randomized controlled studies and cohort studies included in the Cochrane library, PubMed, and Embase from March 2012 to March 2022 in English. The included studies were ACLR with or without remant preservation, and the data were extracted and the quality of the included studies was assessed by two authors, respectively. Revman 5.4 was used for statistical analysis and conclusions were presented.ResultTen articles containing a total of 777 patients were finally included. There was no significant difference in postoperative Lachman test [OR = 1.66, 95%CI (0.79, 3.49), P = 0.18 > 0.05], Tegner score [SMD = −0.13, 95%CI (−0.47, 0.22), P = 0.46 > 0.05], synovial coverage rate by second-look arthroscopy [OR = 1.55, 95%CI (0.66, 3.65), P = 0.32 > 0.05], the rate of cyclops lesion [OR = 3.92, 95%CI (0.53, 29.29), P = 0.18 > 0.05], joint range of motion [SMD = 0.27, 95%CI (−0.13, 0.68), P = 0.19 > 0.05] and re-injury rate [OR = 0.57, 95%CI (0.18, 1.74), P = 0.32 > 0.05] between the two groups. There were statistically significant differences in postoperative Lysholm score [SMD = 0.98, 95% CI (0.32, 1.64), P = 0.004 < 0.05], International Knee Documantation Committee grade (IKDC grade) [OR = 2.19, 95%CI (1.03, 4.65), P = 0.04 < 0.05], Pivot shift test [OR = 1.71, 95%CI (1.06, 2.77), P = 0.03 < 0.05], KT1000/2000 arthrometer side-to-side difference [SMD = −0.22, 95%CI (−0.42, −0.03), P = 0.02 < 0.05], operation time [SMD = 11.69, 95%CI (8.85, 14.54), P = 0.00001 < 0.05] and degree of tibial tunnel enlargement [SMD = −0.66, 95%CI (−1.08, −0.23), P = 0.002 < 0.05].ConclusionThis meta-analysis concluded that remnant preservation significantly had better results in terms of patient functional score (Lysholm, IKDC), knee stability (Pivot shift test, postoperative side-to-side anterior laxity) and tibial tunnel enlargement. In terms of complications (incidence of Cyclops lesions, range of motion, re-injury rate), no significant differences were seen between the two groups. Although many studies concluded that remnant preservation could bring better synovial coverage, this meta-analysis indicated that there is insufficient evidence to support it, possibly due to different remnant preservation procedures.The potential risks associated with longer operation times are also worth considering.

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Section: Discussionmentioning

confidence: 94%

Effects of remnant preservation in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

Xie

Zhong

et al. 2022

Front. Surg.

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“…In ACL reconstruction surgery, the importance of surgical planning is supported by the evidence that up to 8.2% of ACLR end in graft failure [7, 9, 11, 19, 22, 29, 34].…”

Section: Discussionmentioning

confidence: 99%

A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction

Minoli,

Travi,

Monti

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The aim of this study is to describe and validate a simple and reliable method to pre-operatively predict the size of the ACL graft in the double strand technique with autologous semitendinosus–gracilis tendons on the same MRI used for ACL rupture diagnosis. Methods The study included 92 patients, with a median age of 31 years (IQR 26–41 years), 73/92 (79%) of whom were males. All patients that underwent an ACL reconstruction with doubled ST + GT between 2017 and 2022 were counted in the study. Results Overall, the median predicted graft diameter from MR imaging was similar to the actual graft diameter with no significant differences (n.s.). Regarding the comparison between predicted and actual graft size, concordance was 78/92 (85%, 95% CI 76–91%), with κ = 0.797 which corresponds to a level of agreement defined as “Strong”. Tendon sizes calculated on pre-operative MRI were evaluated both with intra-observer and inter-observer reliability demonstrating a statistically reproducible method. The predicted graft was then compared to the reported one with a statistically significant reliability found. Conclusion This study can help the surgeons to perform a fast pre-operative planning of an ACL reconstruction for graft selection. If the planned graft with ST and GT is smaller than 8 mm, the clinician can decide to switch to a different type of graft or plan a different graft preparing technique and, therefore, reduce the risk of post-operative ligament re-rupture. The method proposed is reliable and reproducible. The major strength of the planning technique proposed is that it relies on data that are already available for the clinician before surgery, without the need of further analysis. Level of evidence IV.

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“…Currently, remnant preservation is commonly performed by passing the grafted tendon through the remnant [8, 11, 17, 19, 26, 34, 37]. Some studies indicated that only tibial tunnel enlargement of single‐bundle ACLR, and only AM bundle tunnel enlargement were reduced by the conventional remnant preservation technique [17, 31, 34, 37].…”

Section: Discussionmentioning

confidence: 99%

A new remnant preservation technique reduces bone tunnel enlargement after anatomic double-bundle anterior cruciate ligament reconstruction

Koyama

Tensho

Shimodaira

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo investigate the effect of a new remnant preservation technique with a focus on remnant continuity on postoperative femoral and tibial tunnel enlargement after anatomical double‐bundle anterior cruciate ligament reconstruction (ACLR). MethodsA total of 150 knees were divided into three groups: Preservation Group (Group P: 49 knees), wherein the remnant continuity remained after tunnel creation; Resection Group (Group R: 47 knees), wherein the remaining remnant was resected, and Absent Group (Group A: 54 knees), wherein the remnant had no femoral attachment before tunnel creation. In Group P, the remnant maintained continuity, and the anteromedial (AM) and posterolateral (PL) bundles were positioned anterior and posterior to the remnant, respectively. Computed tomographic scans were performed at 1 week and 1 year after surgery, and the cross‐sectional area of each tunnel aperture was measured. Tunnel enlargement was compared among the three groups by one‐way analysis of variance (ANOVA) and the Bonferroni test. Univariate and multivariate logistic analyses were performed to identify the risk factors for tunnel enlargement in demographic and radiographic data. ResultFor femoral AM tunnels, the tunnel enlargement of Group P was significantly smaller than Groups R and A (p < 0.001), femoral PL (p < 0.001 vs. R and A), tibial AM (p < 0.001 vs. R, 0.002 vs. A), and tibial PL (p < 0.001 vs. R, 0.002 vs. A). There was no significant difference between Groups R and A. Multivariate logistic analysis showed that remnant preservation was a significant factor in reducing tunnel enlargement in the femoral AM, femoral PL, tibial AM, and tibial PL. ConclusionThe new remnant‐preserving anatomical double‐bundle ACLR, which preserves the continuity of the remnant, prevented all bone tunnel enlargement at 1 year postoperatively. Level of evidenceLevel III.

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Remnant preserving ACL reconstruction with a functional remnant is related to improved laxity but not to improved clinical outcomes in comparison to a nonfunctional remnant

Cited by 13 publications

References 70 publications

Effects of remnant preservation in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

Effects of remnant preservation in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction

A new remnant preservation technique reduces bone tunnel enlargement after anatomic double-bundle anterior cruciate ligament reconstruction

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