Anatomical Remnant-Preserving Double-Bundle ACL Reconstruction With a New Remnant Augmentation Technique

Abstract

Anterior cruciate ligament (ACL) remnant preservation techniques have been recently introduced for covering the graft with remnant to improve the clinical results of ACL reconstruction. Several theoretical advantages exist for this technique; however, clinical results remain inconsistent and controversial. We have focused on the biomechanical function of the remnant and have been performing a new remnant-preserving reconstruction procedure that augments the graft with residual remnant. Preserving the structure and continuity of good-quality remnants may help maintain the early postoperative stress on the tendon graft, thereby providing a positive effect on remodeling. Although our concept is significantly different from previously reported remnant preservation techniques and has several pitfalls, the surgical technique that we outline in this report is simple and does not require specialized equipment. The procedure will also work more advantageously in preserving the residual mechanoreceptors in the remnant. We believe that this method can be a procedure with better results for patients with remnants that are in good condition.

Clinical outcome of a new remnant augmentation technique with anatomical double-bundle anterior cruciate ligament reconstruction: Comparison among remnant preservation, resection, and absent groups

“…In comparing the three groups in this study, the group that underwent new remnant-preserving anatomical double-bundle ACL reconstruction 16 showed no significant differences in clinical scores compared to the resected remnant group and the absent group. However, the preserved group had significantly better anterior stability than both the resected and absent groups.…”

“…Surgery was performed based on the method described by Tensho et al. 16 The patient was placed in the supine position, and the affected limb was flexed 90° at the knee joint. In preparing the graft tendon, the ipsilateral semitendinosus tendon and, in some cases, the gracilis tendon were double- or quadruple-bundled.…”

“…With a focus on these residual mechanical properties of the remnant, a new anatomical ACL double-bundle reconstruction technique was reported which emphasized the preservation of continuity without damaging the remnant during the reconstruction process and the augmentation of the reconstructed graft using the residual remnant. 16 This method is novel in that the AM bundle is placed anterior to the remnant and the PL bundle is placed posterior to the remnant so that the bone tunnel can be created in an anatomical position without damaging the continuity of the remnant, whereas the graft is passed through the remnant in conventional methods. However, there are no studies that verify the effects of new remnant-preserving method that differ from conventional methods, how this affects the clinical outcome and postoperative anterior stability after ACL reconstruction, and whether there is a difference in the frequency of complications including cyclops syndrome.…”

Remnant Tensioning Through Pullout Sutures From the Femoral Tunnel During Anatomic Anterior Cruciate Ligament Reconstruction

“…This concept has led to increased interest in studies of remnant preservation, proven by the recent surge in publications in the field of repair and remnant preservation. 2 , 3 , 6 , 7 , 8 , 12 Because of newer information about the remnant, ACL is now considered as an organ with neural and vascular tissues and not merely a stabilizing structure. 11 Many histologic studies have confirmed that remnants of torn ACL retain vascularized synovial sheets, numerous fibroblasts and myofibroblasts, and various mechanoreceptors.…”

“…5 Various techniques of remnant tensioning are described in the literature, but they are technically demanding and difficult to replicate. [6][7][8] Some of these techniques need separate fixation devices for the remnant, making those techniques costly and nonanatomical. 6 Some require a sizeable outside incision to secure remnant sutures, whereas some require tampering with a primary suspensory fixation device for graft.…”