ArticlePDF Available

Anterior Cruciate Ligament Reconstruction of the Knee Using Double Bundle Hamstring Autograft - Is the Remnant Preservation Technique Superior to the Standard Procedure in Terms of Long-Term Graft Failure Rate, the Need for Revision Operation, and Associated Clinical Dysfunction?: A 10 Year Post Operative Follow-Up Chart Review from a Previous Prospective Randomised Controlled Study

Authors:
  • Perth Orthopaedic and Sports Medicine Centre, Perth ,Western Australia

Abstract

Background Anterior cruciate remnant preservation may be beneficial in Anterior Cruciate Ligament Reconstruction (ACLR). Gohil, Annear & Breidahl (Sept, 2007) used a grade 1 randomised controlled trial to compare the two methods and at short term follow-up, the minimal debridement technique demonstrated earlier revascularisation within the ACL graft at 2 months, and suggested improved strength at 6 months based on radiological imaging. Unfortunately, this did not translate through to clinical benefits in the early 12 month post operative period. Zhang, L et al. (May, 2013) and Naylor, AJ et al. (2013) reiterated that remnant preservation may improve graft revascularization and knee proprioception. Takazawa Y et al. (Sept, 2013) demonstrated that minimal debridement may facilitate recovery of function and decreased graft rupture at two years post primary reconstruction. However, studies have yet to show consistent significant clinical advantages and follow-up has only been analysed over 1-2 years. Purpose This current study reported results over a long-term follow-up of 10 years post operation for the same participants from the Gohil, Annear & Breidahl (2007) study. Study Design The review was based on level 1 randomised controlled trial chart review. Methods All 49 participants (25 standard – group 1, and 24 remnant preserving group – group 2) from the previous study have been included for investigation. The chart review recorded demographic data, graft rupture, re-operation rates, and associated clinical failures of the ACLR. The review presents comparative data between the two groups. Results At 10 year follow-up, the remnant retention ACLR group only had better outcomes for ipsilateral graft rupture (2 patients versus 3 patients). Standard ACLR group had improved outcomes for contralateral graft rupture (2 versus 3), ipsilateral other knee post operative surgery (5 versus 10), ipsilateral knee post operative complaints (7 versus 12), and other non-knee post operative issues (3 versus 4). Non of the differences were statistically significant. Conclusion Overall our results suggested no statistically significant difference between the remnant retaining and standard technique for ACLR in these 49 subjects using chart review endpoints of graft revision and knee reoperation rates. The review is limited by a small study group and a chart only review. A larger study group with long term clinical outcome measures may offer more definitive conclusions as to the advantages of remnant sparing ACLR. In this 10 year follow-up post ACL reconstruction there has been no distinct advantage identified for either procedure.
1
This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License
(http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium,
provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints
and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Anterior Cruciate Ligament Reconstruction of the Knee Using Double Bundle Hamstring Autograft
- Is the Remnant Preservation Technique Superior to the Standard Procedure in Terms of Long-
Term Graft Failure Rate, the Need for Revision Operation, and Associated Clinical Dysfunction? :
A 10 Year Post Operative Follow-Up Chart Review from a Previous Prospective Randomised
Controlled Study
Peter Annear
1
, E Rohr
2
1
Perth Orthopaedics and Sports Medicine Centre, Perth, Australia,
2
Royal Perth Hospital, Perth, Australia
Background: Anterior cruciate remnant preservation may be beneficial in Anterior Cruciate Ligament
Reconstruction (ACLR). Gohil, Annear & Breidahl (Sept, 2007) used a grade 1 randomised controlled trial to
compare the two methods and at short term follow-up, the minimal debridement technique demonstrated earlier
revascularisation within the ACL graft at 2 months, and suggested improved strength at 6 months based on
radiological imaging. Unfortunately, this did not translate through to clinical benefits in the early 12 month post
operative period. Zhang, L et al. (May, 2013) and Naylor, AJ et al. (2013) reiterated that remnant preservation may
improve graft revascularization and knee proprioception. Takazawa Y et al. (Sept, 2013) demonstrated that minimal
debridement may facilitate recovery of function and decreased graft rupture at two years post primary
reconstruction. However, studies have yet to show consistent significant clinical advantages and follow-up has only
been analysed over 1-2 years.
Purpose: This current study reported results over a long-term follow-up of 10 years post operation for the same
participants from the Gohil, Annear & Breidahl (2007) study.
Study Design: The review was based on level 1 randomised controlled trial chart review.
Methods: All 49 participants (25 standard – group 1, and 24 remnant preserving group – group 2) from the previous
study have been included for investigation. The chart review recorded demographic data, graft rupture, re-operation
rates, and associated clinical failures of the ACLR. The review presents comparative data between the two groups.
Results
At 10 year follow-up, the remnant retention ACLR group only had better outcomes for ipsilateral graft rupture (2
patients versus 3 patients). Standard ACLR group had improved outcomes for contralateral graft rupture (2 versus
3), ipsilateral other knee post operative surgery (5 versus 10), ipsilateral knee post operative complaints (7 versus
12), and other non-knee post operative issues (3 versus 4). Non of the differences were statistically significant.
Conclusion: Overall our results suggested no statistically significant difference between the remnant retaining and
standard technique for ACLR in these 49 subjects using chart review endpoints of graft revision and knee
reoperation rates. The review is limited by a small study group and a chart only review. A larger study group with
long term clinical outcome measures may offer more definitive conclusions as to the advantages of remnant sparing
ACLR. In this 10 year follow-up post ACL reconstruction there has been no distinct advantage identified for either
procedure.
The Orthopaedic Journal of Sports Medicine, 4(2)(suppl 1)
DOI: 10.1177/2325967116S00005
©The Author(s) 2016
by guest on March 19, 2016ojs.sagepub.comDownloaded from
ResearchGate has not been able to resolve any citations for this publication.
ResearchGate has not been able to resolve any references for this publication.