A Pilot Study of Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With Ligament Remnant Tissue Preservation

Abstract

Purpose: The purpose of this pilot study is to clarify the preliminary results of an anatomic double-bundle ACL reconstruction procedure with ligament remnant tissues. Methods:Using the trans-tibial technique, 2 doubled semitendinosus tendons were grafted into 4 tunnels created at the center of each bundle attachment, penetrating the ACL remnant tissue. Forty-four patients (27 men and 17 women) with an isolated ACL injury underwent ACL reconstruction using this procedure. The mean age of subjects was 29 years (range: 17-58). Postoperative clinical evaluations were performed at 16.6 months on average (range: 12 -23). Radiological evaluations were also performed to evaluate the tunnel location in the femur and the tibia. Results:The average operation time was 86 minutes (range: 72 -96) in the cases with ACL reconstruction only. Postoperatively, the mean anterior laxity was 0.7 mm. The postoperative pivot-shift test was negative in 81.8 % of the patients, while there were no patients evaluated as ++. No patients showed any extension or flexion deficit. There were no patients evaluated as "Nearly abnormal" or "Abnormal" under the IKDC evaluation. The tunnel angles of the 4 tunnels were identical to those reported in the previous study. Conclusions:The minimal 1-year clinical results of anatomic double-bundle ACL 3 reconstruction with ligament remnant tissue preservation were comparable to the previously reported results of the anatomic double-bundle reconstruction without remnant tissue preservation.

Comparison of graft bending angle during knee motion after outside-in, trans-portal and trans-tibial anterior cruciate ligament reconstruction

“…Currently, OI and TP techniques are popular techniques for drilling femoral tunnels in anatomic ACL reconstruction [8,9,12,20,25,29,30,32,34,51,54,56], and modified TT technique has been also reported to achieve anatomic placement of the grafts within ACL footprint [14,58,59]. Recent studies on GBA evaluated by postoperative CT have reported that OI technique resulted in more steep GBA than in TP technique, with about 80° GBA by OI technique [23,40,50], and these results were similar to our findings at full extension.…”

Evaluation of a behind-remnant approach for femoral tunnel creation in remnant-preserving double-bundle anterior cruciate ligament reconstruction — Comparison with a standard approach

“…If the remnant preserving technique is performed without any removal of the remnant tissue at the femoral side, it is very difficult to locate the appropriate tunnel position with arthroscopic observation of the frontside of the remnant tissue, since the intercondylar ridge is hard to detect. Therefore, it is often necessary to confirm the tunnel position by X-ray [26]. We performed the standard approach by only residual tissue of the normal femoral attachment area being peeled off as little as possible but enough to detect the intercondylar ridge; however, some extent of the remnant at the femoral side had to be removed.…”

“…Recently, the remnant preserving technique has been recommended based on the theoretical advantages such as proprioceptive function preservation [20][21][22][23], stability preservation [24,25], and graft healing [26][27][28][29]. A recent study also showed that the remnant tissue can be used for a landmark of anatomic positioning of the tunnels, not only for the tibial side but also for the femoral side [30].…”

Preoperative assessments completed for anterior cruciate ligament reconstructions with remnant preservation

“…2e5,8,12,17e21 ACL remnants make a biomechanical contribution to AP and rotational knee stability in patients with a complete ACL injury. 6 ACL remnants contributed to AP knee stability evaluated at 30 of knee flexion for up to one year after injury. 22 Adachi et al reported that significantly better results of position sense and joint stability were obtained from ACL augmentation (with remnant preservation) than from conventional ACL reconstruction (without remnant preservation).…”