Anterior cruciate ligament augmentation under arthroscopy

Abstract

We present a new surgical technique of anterior cruciate ligament (ACL) augmentation using autogenous hamstring tendons or allogenic fascia lata under arthroscopy for patients in whom considerable ACL remnants with mechanoreceptors are preserved. We review the clinical results of 40 patients who underwent this ACL augmentation, as assessed by manual instability tests, KT-2000 knee arthrometer, Lysholm and Gillquist score, joint position sense and magnetic resonance imaging (MRI), and compare them with those of ACL reconstruction. The side-to-side differences of anterior displacement measured by the KT-2000 knee arthrometer at 30 lbs, an average of 5.3 +/- 2.6 mm preoperatively, was significantly improved to an average of 0.7 +/- 1.8 mm in the augmentation group, while an average of 6.0 +/- 2.4 mm was improved to 1.8 +/- 2.1 mm in the reconstruction group. There was no statistically significant difference between the preoperative values in the two groups, but the postoperative values of the augmentation group were significantly less than those of the reconstruction group. The ratio of anterior terminal stiffness of the augmentation group was 1.2 +/- 1.8, and that of the ACL reconstruction group was 0.7 +/- 0.4. This was a statistically significant difference (P < 0.05). Thus, as for the KT-2000 knee arthrometer, the ACL augmentation group showed significantly better anteroposterior stability and terminal stiffness than the ACL reconstruction group. The final inaccuracy of joint position sense of the augmentation group was 0.7 degrees +/- 0.7 degrees, while that of the reconstruction group was 1.7 degrees +/- 1.2 degrees indicating a significant difference (P < 0.05). This study demonstrates that ACL augmentation, which can preserve ACL remnants with mechanoreceptors, is superior to ACL reconstruction from the viewpoint of position sense and joint stability.

Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

“…[14][15][16][17] Therefore it seems reasonable to assume that the remnant tissue could be preserved, especially the tibial side, as a source of reinnervation if impingement and cyclops lesions can be prevented. 1,4,5,18 However, during remnant preservation, using an anterior portal could interfere with restoration of the anatomic footprint because remnant tissue could be an obstacle to formation of an anatomic tunnel location.…”

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

“…[11][12][13][14][15][16] On the other hand, only a clinical report 17 has introduced a remnant-preserving technique for double-bundle ACL reconstruction, in which 2 femoral tunnels and one tibial tunnel were made, although anatomic double bundle ACL reconstruction procedures have recently attracted notice because of biomechanical advantages in laboratory studies. [18][19][20][21][22][23][24][25][26][27][28] However, no previous studies have shown clinical evidence about utility of the ACL remnant tissue preservation in ACL reconstruction as of yet.…”

Anterior Cruciate Ligament Reconstruction With Preservation of Femoral Anterior Cruciate Ligament Stump

“…3,4 When a continuous ACL remnant is available, its preservation has been shown to improve vascularization of the ACL graft, blood flow, ligamentization, tendon-to-bone integration, and proprioceptive function. [3][4][5][6] Such improvement has also been suggested with even tibial stump preservation in cases in which there is no continuous remnant between the femur and tibia. 1,2,7,8 Morphologically normal mechanoreceptors have been shown to be present in both tibial and femoral ACL stumps biopsied during ACL reconstructions.…”