Comparison of Clinical Results According to Amount of Preserved Remnant in Arthroscopic Anterior Cruciate Ligament Reconstruction Using Quadrupled Hamstring Graft

Department of Orthopedic Surgery, Soonchunhyang University Hospital, Seoul, South Korea.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 06/2008; 24(5):560-8. DOI: 10.1016/j.arthro.2007.11.011
Source: PubMed


The purpose of this study was to analyze the clinical results of anterior cruciate ligament (ACL) reconstruction with the remnant-preserving technique by use of a hamstring graft and looped sutures according to the amount of the tibial remnant of the ACL.
Sixteen subjects had undergone ACL reconstruction with the remnant-preserving technique by use of 4 strands of a hamstring tendon and a looped suture technique and were followed up for at least 12 months. The mean follow-up was 35.1 months. At the last follow-up examination, the patients were evaluated with the International Knee Documentation Committee scale and Hospital for Special Surgery score as subjective tests; stress radiographs, Lachman test, and anterior drawer test by use of the KT-2000 arthrometer (MEDmetric, San Diego, CA) as objective tests; and single-legged hop test, reproduction of passive positioning, threshold to detection of passive motion, and single-limb standing test as functional tests. On the basis of the extent of ACL remnant, patients were then divided into 2 groups. Group I comprised patients with more than 20%, and group II comprised those with less than 20%. For each of the 2 groups, a statistical comparison of the final results was made.
The mean Hospital for Special Surgery score improved from 65.8 (preoperatively) to 95.2 (at last follow-up). Functional evaluation revealed that the difference was not significant in terms of mechanical stability, but a significant difference was detected in functional outcome and proprioception. Regarding the threshold to detection of passive motion at 30 degrees (P = .030) and reproduction of passive positioning at 15 degrees (P = .032) and 30 degrees (P = .024), group I (> 20%) showed better results than group II (< 20%).
We confirmed that the remnant-preserving technique described showed good proprioceptive and functional outcomes with statistical significance. Therefore it may be expected that the more the tibial remnant is kept intact, the better the preservation of proprioceptive function will be.
Level IV, prognostic case series.

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    • "Mechanoreceptors in the ACL are proposed to play a role in preserving and restoring joint stability. Therefore, it may be expected that the more the tibial remnant is kept intact, the better the preservation of proprioceptive function [14] [29]. ACL remnants may accelerate the cellular proliferation and revascularization of the grafted tendon [30]. "
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    ABSTRACT: Purpose The aim of this study was to investigate the histological features of the remaining fibers bridging femur and tibia in partial ACL tears. Methods 26 ACL remnants were harvested from patients who had arthroscopic criteria concordant with a partial tear. Histological analysis includes cellularity, blood vessel density evaluation and characterization of the femoral bony insertion morphology. Immunohistochemical studies were carried out to determine cell positive for α-smooth actin and for mechanoreceptors detection. Results In this samples, a normal femoral insertion of the remnant was present in 22.7% of the cases. In 54 % of the samples, substantial areas of hypercellularity were observed. Myofibroblasts were the predominant cell type and numerous cells positive for α-smooth actin were detected at immunostaining. Blood vessel density was increased in hypercellularity areas and in the synovial sheet. Free nerve endings and few Golgi or Ruffini corpuscles were detected in 41 % of the specimens. The cellularity was correlated to the time between injury to surgery (p = .001). Conclusion Competent histological structures including a well vascularized synovial sheet, numerous fibroblasts and myofibroblasts and mechanoreceptors were found in ACL remnants. These histological findings bring additional knowledge towards the preservation of the ACL remnant in partial tears when ACL reconstruction or augmentation is considered.
    The Knee 07/2014; 21(6). DOI:10.1016/j.knee.2014.07.020 · 1.94 Impact Factor
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    • "However it is well known that tibial remnants contain several types of mechanoreceptors. These mechanoreceptors may provide positive effects on the proprioceptive function of the knee25,26). It has been suggested that the ACL secondarily functions as a sensory organ providing proprioceptive feedback and initiating protective reflexes and stabilizing muscular reflexes. "
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    ABSTRACT: The advances in the knowledge of anatomy, surgical techniques, and fixation devices have led to the improvement of anterior cruciate ligament (ACL) reconstruction over the past 10 years. Nowadays, double bundle and anatomical single bundle ACL reconstruction that more closely restores the normal anatomy of the ACL are becoming popular. Although there is still no definite conclusion whether double bundle ACL reconstruction provides better clinical results than single bundle reconstruction, the trend has shifted to anatomic reconstruction regardless of single bundle or double bundle techniques. We could not find any significant differences in the clinical outcomes and stability after ACL reconstruction according to the type of graft or fixation device. Therefore, surgeons should select an ideal ACL reconstruction according to the patient's condition and surgeon's experience.
    12/2013; 25(4):165-173. DOI:10.5792/ksrr.2013.25.4.165
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    • "The interest of this technique is in some ways the same as that of partial reconstruction: • improved ligamentization thanks to vascularization from the conserved synovium [28]; • improved proprioception thanks to the mechanical receptors of the residual LCA [29]. "
    Article: ACL tear
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    ABSTRACT: Anterior cruciate ligament (ACL) reconstruction has evolved considerably over the past 30years. This has largely been due to a better understanding of ACL anatomy and in particular a precise description of the femoral and tibial insertions of its two bundles. In the 1980s, the gold standard was anteromedial bundle reconstruction using the middle third of the patellar ligament. Insufficient control of rotational laxity led to the development of double bundle ACL reconstruction. This concept, combined with a growing interest in preservation of the ACL remnant, led in turn to selective reconstruction in partial tears, and more recently to biological reconstruction with ACL remnant conservation. Current ACL reconstruction techniques are not uniform, depending on precise analysis of the type of lesion and the aspect of the ACL remnant in the intercondylar notch.
    Orthopaedics & Traumatology Surgery & Research 01/2013; 99(1). DOI:10.1016/j.otsr.2012.11.012 · 1.26 Impact Factor
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