Anterior cruciate ligament remnant and its values for preservation

Muneta, Takeshi; Koga, Hideyuki

doi:10.1016/j.asmart.2016.09.002

Cited by 16 publications

(23 citation statements)

References 46 publications

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“…[1,[15][16][17][18]. Furthermore, the strength of the remnant tissue in the early phase after reconstruction may be beneficial for rehabilitation and early incorporation [19]. Nagai et al [20] reported that ACL remnants partially contributed to anterior-posterior stability.…”

Section: Introductionmentioning

confidence: 99%

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Anterior cruciate ligament remnant‐preserving and re‐tensioning reconstruction: a biomechanical comparison study of three different re‐tensioning methods in a porcine model

Ryu

Kwon

Hong

et al. 2021

BMC Musculoskelet Disord

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Background With the developments in the arthroscopic technique, anterior cruciate ligament (ACL) remnant-preserving reconstruction is gradually gaining attention with respect to improving proprioception and enhancing early revascularization of the graft. To evaluate the mechanical pull-out strength of three different methods for remnant-preserving and re-tensioning reconstruction during ACL reconstruction. Methods Twenty-seven fresh knees from mature pigs were used in this study. Each knee was dissected to isolate the femoral attachment of ACL and cut the attachment. An MTS tensile testing machine with dual-screw fixation clamp with 30° flexion angle was used. The 27 specimens were tested after applying re-tensioning sutures with No. 0 polydioxanone (PDS), using the single stitch (n = 9), loop stitch (n = 9), and triple stitch (n = 9) methods. We measured the mode of failure, defined as (1) ligament failure (longitudinal splitting of the remnant ACL) or (2) suture failure (tearing of the PDS stitch); load-to-failure strength; and stiffness for the three methods. Kruskal-Wallis test and Mann-Whitney U-test were used to compare the variance of load-to-failure strength and stiffness among the three groups. Results Ligament failure occurred in all cases in the single stitch group and in all but one case in the triple stitch group. Suture failure occurred in all cases in the loop stitch group and in one case in the triple stitch group. The load-to-failure strength was significantly higher with loop stich (91.52 ± 8.19 N) and triple stitch (111.1 ± 18.15 N) than with single stitch (43.79 ± 11.54 N) (p = 0.002). With respect to stiffness, triple stitch (2.50 ± 0.37 N/mm) yielded significantly higher stiffness than the other methods (p = 0.001). Conclusions The results suggested that loop stitch or triple stitch would be a better option for increasing the mechanical strength when applying remnant-preserving and re-tensioning reconstruction during ACL reconstruction.

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Section: Introductionmentioning

confidence: 99%

“…Nagai et al [20] reported that ACL remnants partially contributed to anterior-posterior stability. For these reasons, it would be better to provide a retensioning method to create a mechanically stable environment as possible [19].…”

Section: Introductionmentioning

confidence: 99%

Anterior cruciate ligament remnant‐preserving and re‐tensioning reconstruction: a biomechanical comparison study of three different re‐tensioning methods in a porcine model

Ryu

Kwon

Hong

et al. 2021

BMC Musculoskelet Disord

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“…5,10, [18][19][20][21][22] The purpose of preservation is to maintain its original anatomical and biomechanical properties. 19,21 Kirizuki et al 5 have showed that the nonreattached remnant type (Crain 4) in the subacute phase after injury has a higher healing potential. Haviv et al 4 have reported that during the first 3 months from injury the gross morphological features of the torn ACL remnant showed no scar (Crain 4) followed by scarring of the femoral remnant at first to the femoral notch, and eventually to the PCL (Crain 1) within 6 months from injury.…”

Section: Discussionmentioning

confidence: 99%

The Reliability of Classifying the Morphology of Anterior Cruciate Ligament Remnants during Surgery

et al. 2019

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Arthroscopic classification of the torn anterior cruciate ligament (ACL) morphology is fundamental for clinical studies on emerging techniques such as repair and preservation. At present, the most acknowledged classification is Crain description of four morphological patterns. The purpose of the study was to analyze the intra- and interobserver reliability of Crain classification in patients undergoing ACL reconstruction surgeries. The study included 101 patients who had ACL reconstruction surgery between the years 2014 and 2017. The morphological pattern of ACL remnant scar formation during surgery was observed and classified according to Crain by three orthopaedic surgeons. Inter- and intraobserver reliabilities were measured using kappa statistics. Intraobserver reliability for the Crain classification ranged from 0.63 to 0.83 (substantial to almost perfect agreement). Interobserver reliability was 0.51 (moderate agreement). In almost a third of the cases, observers reported on additional morphological pattern of scar formation that was not well defined by Crain. A modified classification of four patterns was suggested: (A) without scar tissue, (B) with adhesion to the femoral notch (wall or roof), (C) with adhesion to the notch and posterior cruciate ligament (PCL), and (D) with adhesion to the PCL. Reanalysis of these four morphological configurations resulted in interobserver reliability of 0.82 (almost perfect agreement). In conclusion, the Crain classification of torn ACL remnant morphology has moderate interobserver reliability; however, a suggested classification with modified and additional configurations has almost perfect reliability and may be useful for studies on ACL repair and preservation.

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“…In particular, negating the requirement for autografts would theoretically solve troublesome donor site morbidity issues such as loss of hamstrings strength and anterior knee pain. Current practices and trends towards remnant preservation and some of the improvements shown in subjective proprioceptive outcomes, knee stability and revision rate (Takazawa et al 2013 ; Takahashi et al 2016 ; Muneta and Koga 2017 ; Andonovski et al 2017 ) can be extrapolated to offer hypothetical benefits for primary repair over reconstruction.…”

Section: Anterior Cruciate Ligament Injuriesmentioning

confidence: 99%

Anterior cruciate ligament repair – past, present and future

2018

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BackgroundThis article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques. PubMed (MEDLINE), EMBASE and Cochrane Library databases for papers relating to primary anterior cruciate ligament reconstruction were searched by all participating authors. All relevant historical papers were included for analysis. Additional searches of the same databases were made for papers relating to biological enhancement of ligament healing.Current standardThe poor capacity of the ACL to heal is one of the main reasons why the current gold standard surgical treatment for an ACL injury in an athletic patient is ACL reconstruction with autograft from either the hamstrings or patella tendon. It is hypothesised that by preserving and repairing native tissues and negating the need for autograft that primary ACL repair may represent a key step change in the treatment of ACL injuries.History of primary ACL repairThe history of primary ACL repair will be discussed and the circumstances that led to the near-abandonment of primary ACL repair techniques will be reviewed.New primary repair techniquesThere has been a recent resurgence in interest with regards to primary ACL repair. Improvements in imaging now allow for identification of tear location, with femoral-sided injuries, being more suitable for repair. We will discuss in details strategies for improving the mechanical and biological environment in order to allow primary healing to occur.In particular, we will explain mechanical supplementation such as Internal Brace Ligament Augmentation and Dynamic Intraligamentary Stabilisation techniques. These are novel techniques that aim to protect the primary repair by providing a stabilising construct that connects the femur and the tibia, thus bridging the repair.Bio enhanced repairIn addition, biological supplementation is being investigated as an adjunct and we will review the current literature with regards to bio-enhancement in the form platelet rich plasma, bio-scaffolds and stem cells. On the basis of current evidence, there appears to be a role for bio-enhancement, however, this is not yet translated into clinical practice.ConclusionsSeveral promising avenues of further research now exist in the form of mechanical and biological augmentation techniques. Further work is clearly needed but there is renewed interest and focus for primary ACL repair that may yet prove the new frontier in ligament repair.

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Anterior cruciate ligament remnant and its values for preservation

Cited by 16 publications

References 46 publications

Anterior cruciate ligament remnant‐preserving and re‐tensioning reconstruction: a biomechanical comparison study of three different re‐tensioning methods in a porcine model

Anterior cruciate ligament remnant‐preserving and re‐tensioning reconstruction: a biomechanical comparison study of three different re‐tensioning methods in a porcine model

The Reliability of Classifying the Morphology of Anterior Cruciate Ligament Remnants during Surgery

Anterior cruciate ligament repair – past, present and future

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