Effects of Remnant Tissue Preservation on Clinical and Arthroscopic Results After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction.

Abstract

BACKGROUND:

Clinical utility of remnant tissue preservation after single-bundle anterior cruciate ligament (ACL) reconstruction has not been established. In addition, no studies have evaluated the clinical utility of remnant preservation after anatomic double-bundle ACL reconstruction.

HYPOTHESIS:

The study hypotheses were as follows: (1) Subjective and functional clinical results may be comparable between anatomic double-bundle reconstructions that preserve the remnant tissue and those that resect the remnant tissue, (2) postoperative knee stability and the second-look arthroscopic evaluation may be significantly more favorable with the remnant-preserving reconstruction, and (3) the degree of the initial graft coverage may significantly affect postoperative knee stability.

STUDY DESIGN:

Cohort study; Level of evidence, 2.

METHODS:

A total of 179 patients underwent anatomic double-bundle ACL reconstruction. Based on the Crain classification of ACL remnant tissue, 81 patients underwent the remnant-preserving procedure (group P) and the remaining 98 patients underwent the remnant-resecting procedure (group R). There were no differences between the 2 groups concerning all background factors, including preoperative knee instability and intraoperative tunnel positions. The patients were followed for 2 years or more.

RESULTS:

The subjective and functional clinical results were comparable between the 2 reconstruction procedures. Side-to-side anterior laxity was significantly less (P = .0277) in group P (0.9 mm) than in group R (1.5 mm). The pivot-shift test was negative in 89% of group P and 78% of group R patients; the result for group R was significantly lower (P = .0460). In the arthroscopic observations, results for group P were significantly better than for group R concerning postoperative laceration and fibrous tissue coverage of the grafts (P = .0479).

CONCLUSION:

Remnant preservation in anatomic double-bundle ACL reconstruction did not significantly improve subjective and functional results in the short-term evaluation, but it significantly improved postoperative knee stability. The degree of initial graft coverage significantly affected postoperative knee stability.

• Authors: Eiji Kondo, Kazunori Yasuda, Jun Onodera, Yasuyuki Kawaguchi, Nobuto Kitamura
• Journal: The American journal of sports medicine (Am J Sports Med) Vol. 43 Issue 8 Pg. 1882-92 (Aug 2015) ISSN: 1552-3365 [Electronic] United States
• PMID: 26068038 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 The Author(s).

Topics

• Adolescent
• Adult
• Anterior Cruciate Ligament (surgery)
• Anterior Cruciate Ligament Injuries
• Anterior Cruciate Ligament Reconstruction (methods)
• Arthroscopy (methods)
• Cohort Studies
• Female
• Humans
• Joint Instability (surgery)
• Knee Joint (surgery)
• Lacerations (physiopathology)
• Male
• Prospective Studies
• Second-Look Surgery
• Transplants
• Young Adult