Retorno ao esporte após reconstrução do LCA com ressecção ou preservação do remanescente

Diaz, Ruben Marcelo Maldonado; Rezende, Fernando Cury; Moscon, Antonio Carlos; Franciozi, Carlos Eduardo da Silveira; Martimbianco, Ana Luiza Cabrera; Duarte, Aires

doi:10.1055/s-0039-3402461

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…The functional remnant preservation is related to better stability than remnant debridement [1, 8, 11, 38, 47, 53]. However, some studies have found no differences comparing remnant preserving to conventional ACLR [4, 12, 14, 18, 23, 40, 54, 57, 59].…”

Section: Discussionmentioning

confidence: 99%

“…Definition of remnant preserving ACLR is still controversial as remnant preserving ACLR can be performed maintaining the functional fibers that still have a mechanical role, passing the graft alongside it or passing the graft inside nonfunctional tissue that would work as a sleeve optimizing graft coverage [1, 2, 4, 12, 14, 18, 19, 23, 24, 26, 27, 31, 38, 45–47, 49, 52, 57, 58].…”

Section: Introductionmentioning

confidence: 99%

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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

Franciozi

Minami

Ambra

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The Anterior cruciate ligament (ACL) remnant has been pointed out as a ligamentization enhancer. Nonetheless, the remaining tissue can be functional if it still provides some stability or nonfunctional. This study intends to compare the clinical results and knee stability of functional vs. nonfunctional remnant preservation ACL reconstruction (ACLR). Methods One hundred and seventy-ive patients with ACL injuries were included and underwent remnant preservation ACLR. They were divided into two groups accordingly to remnant tissue functionality: functional (Group F) and nonfunctional (Group NF). Primary outcome was deined as patient reported outcomes measured with Lysholm, IKDC and Tegner continuous scales and improvements. Secondary outcomes comprised of Lachman test, anterior drawer test, pivot shift test, extension and lexion deicit, graft coverage by remnant preserved tissue and failure rate (persistent instability or new ACL lesion). Menisci lesions, cartilage lesions and time to surgery were also recorded for each group.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Minami

Ambra

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

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Comparing Clinical Outcomes and Knee Stability in Remnant- Preserving ACL Reconstruction Versus Standard ACL Reconstruction: A Systematic Review and Meta-analysis

Allende,

Allahabadi,

Sachdev

et al. 2024

Am J Sports Med

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Background: Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed procedures in sports medicine, and undesirable outcomes still may range from 3-18%. One technique that has been explored to improve outcomes is preservation of the ACL remnant tibial stump, as opposed to stump debridement, at the time of reconstruction. Purpose: To review current high-level evidence and compare remnant-preserving anterior cruciate ligament reconstruction (ACLR) versus standard ACLR in terms of clinical outcomes and measures of knee stability. Hypothesis: ACLR with remnant preservation would result in improved clinical outcomes and knee stability measures. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review of randomized controlled trials (RCTs) and cohort studies comparing remnant-preserving ACLR with standard ACLR with a minimum level of evidence of 2 was performed. Extracted data were summarized as general information, surgical characteristics, postoperative clinical outcomes, knee stability, graft evaluation, tunnel assessment, and postoperative complications. When feasible, a meta-analysis was performed. Results: Seven RCTs and 5 cohort studies met the inclusion criteria. In total, 518 patients underwent remnant-preserving ACLR and 604 patients underwent standard ACLR. Ten studies performed the reconstruction with hamstring tendon (HT) autografts, 1 study with HT and bone–patellar tendon–bone autografts, and 1 study with HT and tibialis anterior allografts. On meta-analysis, remnant-preserving ACLR provided comparable outcomes with respect to International Knee Documentation Committee grades or Tegner scores. Even though there was a significant improvement in Lysholm scores (mean difference, −1.9; 95% CI, −2.89 to −0.91; P = .0002) with the remnant-preserving technique, this did not exceed previously reported minimal clinically important difference values. Remnant-preserving ACLR demonstrated superior knee stability in terms of patients achieving negative pivot shift when compared with the control group (88.89% vs 79.92%; P = .006). Although there was a significant improvement in the side-to-side difference in anterior tibial translation favoring remnant preservation ( P = .004), the mean difference was 0.51 mm. Conclusion: Remnant-preserving ACLR, primarily with HT autografts, results in comparable clinical outcome scores and significantly improved knee stability relative to standard ACLR without remnant preservation without increasing the complication rate. Further studies will help clarify if remnant-preserving ACLR also has benefits in terms of enhancing graft integration and maturation, improving proprioception, limiting tunnel enlargement, and reducing complications.

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Retorno ao esporte após reconstrução do LCA com ressecção ou preservação do remanescente

Cited by 2 publications

References 20 publications

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

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

Comparing Clinical Outcomes and Knee Stability in Remnant- Preserving ACL Reconstruction Versus Standard ACL Reconstruction: A Systematic Review and Meta-analysis

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