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: 3.1). 06/2008; 24(5):560-8. DOI: 10.1016/j.arthro.2007.11.011
Source: PubMed

ABSTRACT 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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    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.
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    ABSTRACT: Backgrounds Although ACL reconstruction is prevalent, the most effective method for ACL reconstruction still remains controversial. The purpose of this study was to evaluate the effect of the preserved remnant in ACL reconstruction on graft morphology at second-look arthroscopy and clinical outcomes. Methods 66 consecutive patients who underwent a second-look arthroscopy after a remnant-preserving ACL reconstruction were enrolled. The patients were divided into two groups according to whether the remnant ACL fibers could be preserved by over 50% (Group I) or not (Group II). The Lysholm score, IKDC subjective score, Tegner activity score, pivot-shift test, and KT-2000 arthrometric findings were evaluated preoperatively and just prior to the second-look arthroscopy to assess clinical outcomes. At second-look arthroscopy, graft morphology was evaluated using hypertrophy rate and synovialization. Results At second-look arthroscopy, the hypertrophy rate of Group I (42.1%) was higher than Group II (25.1%), which was statistically significant (p = 0.002). In graft synovialization, there was a statistically significant difference between two groups (p < 0.001). The IKDC subjective score improved from 42.9, 43.1 to 77.8, 75.0 for Group I and Group II, respectively (p = 0.025). For the Lysholm score, Group I and Group II improved from 55.4, 55.7 to 87.8, 84.9 (p = 0.031). There was also a significant difference between the pivot shift tests between the groups (p = 0.039). Other clinical tests showed no statistically significant differences. Conclusion Preserving the remnant ACL tissue during ACL reconstruction could have a positive effect on graft hypertrophy, synovialization and clinical outcomes. Level of Evidence III, retrospective comparative study.
    The Knee 01/2014; · 2.01 Impact Factor