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

Ryu, Dong Jin; Kwon, Kyeu-Back; Hong, Da Hee; Park, Sang Jun; Park, Jae Sung; Wang, Joon Ho

doi:10.1186/s12891-021-03955-w

Cited by 4 publications

(13 citation statements)

References 36 publications

(90 reference statements)

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“…5 There are various methods of remnant tensioning, but this requires an extra procedure or manipulation with fixation devices. 6 Our technique is an easy and reproducible technique of remnant tensioning with no added costs or incisions. The prerequisite of remnant tensioning is a good-quality remnant.…”

Section: Discussionmentioning

confidence: 99%

“…These added advantages of remnant preservation led to better functional results than remnant sacrificing ACL reconstruction despite comparable mechanical stability. 1,6,11,13 Although remnant-preservation techniques have shown promising results, this technique is reported to have complications like cyclops formation, loss of extension, and painful extension. These complications result from remnants falling anteriorly as most of the ACL tear occurs from the femoral side.…”

Section: Discussionmentioning

confidence: 99%

“…Improved vascularity because of stretching of kinked vessels. 6. No need for an extra fixation device or incision for remnant fixation.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

“… 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. Most of these techniques vary in femoral fixation methods.…”

mentioning

confidence: 99%

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

Joshi

Basukala

Singh

et al. 2021

Arthroscopy Techniques

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Even after anterior cruciate ligament (ACL) tear, its remnant retains the vascularized synovial sheets, fibroblasts, myofibroblasts, and various mechanoreceptors within it. The aim of preserving the remnant is to retain these components during ACL reconstruction. In the recent past, there has been an increasing trend towards preserving remnants during ACL reconstruction. Although preserving remnants have physiological advantages, cyclops lesion and extension loss were among the most feared complications. Cyclops and loss of extension are due to the fallback of the remnant into the notch. Moreover, the mechanoreceptors present in the remnant are not active when the remnant is lax. These mechanoreceptors are active when the remnant is in tension. Thus, rather than merely preserving the remnant, it is essential to tension it for more physiological functions. Although there are various techniques of remnant tensioning described in the literature, these techniques require tampering of the fixation devices or an extra fixation device adding to the cost of surgery. We describe our modification of the remnant-tensioning method during anatomic ACL reconstruction. In this technique, the sutures holding the remnant are pulled out through the anatomic femoral tunnel and fixed with an interference screw along with the hamstring graft. This technique is cost-effective, reproducible, and does not require tampering with the fixation devices. Moreover, the direction of remnant pull will be the same as that of the reconstructed graft making both the graft and remnant anatomical in orientation. Suture management and visibility of the intraarticular structures during this procedure are a few downsides of this technique. The only prerequisite of this technique is a good quality remnant to hold the sutures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Improved vascularity because of stretching of kinked vessels. 6. No need for an extra fixation device or incision for remnant fixation.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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

Joshi

Basukala

Singh

et al. 2021

Arthroscopy Techniques

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Refixation of the anterior cruciate ligament: A biomechanical analysis of suture techniques in a porcine model

Lutter,

Hiller,

Sass

et al. 2024

J. exp. orthop.

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PurposeRefixation of acute anterior cruciate ligament (ACL) tears represents an increasingly popular treatment option. Systematic evaluations of various suture technique parameters are still pending. We therefore aimed to evaluate the mechanical pull‐out outcomes of various suture methods for optimization of ACL refixation.MethodsSixty fresh knees from mature domestic pigs were dissected and the femoral attachment of the ACL was peeled off. The 60 knees were divided in 10 groups and sutured as follows: (A) one suture (1, 2, 4 and 6 passes), (B) two sutures (2, 4 and 6 passes each; sutures knotted together as a loop) and (C) two sutures (2, 4 and 6 passes each, sutures knotted separately). The pull‐out test was conducted using a validated electrodynamic testing machine. First occurrence of failure, maximum pull‐out load and stiffness were measured. Suture failure was defined as pull‐out of the ACL.ResultsTwo‐point fixation, using two sutures, with at least two passes, showed the most favourable biomechanical stability. The maximum pull‐out load was significantly higher with two sutures (529.5 N) used compared to one (310.4 N), p < 0.001. No significant differences were found for maximum pull‐out loads between two‐point fixation versus one‐point fixation but stiffness was significantly higher with two‐point fixation (107.4 N/mm vs. 79.4 N/mm, p < 0.001). More passes resulted in higher maximum pull‐out loads.ConclusionThe results suggest using two independent sutures, refixed separately and at least two suture passes, is appropriate for ACL refixation. More suture passes provide additional strength but are technically challenging to achieve during surgery.Level of EvidenceLevel IV.

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Remnants-preserving ACL reconstruction using direct tendinous graft fixation: a new rat model

et al. 2022

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Background Anterior cruciate ligament (ACL) repair techniques are new emerging strategies prevailing, in selected cases, over standard reconstruction of the ACL with excision of its remnants. Mid-substance ACL tears represent a challenge for ACL repair techniques, and remnants-preserving ACL reconstruction (rp-ACLR) using an autograft remains the recommended treatment in this situation. However, morbidity associated with the autograft harvesting prompts the need for alternative surgical strategies based on the use of synthetic scaffolds. Relevant small animal models of mid-substance tears with ACL remnants preservation and reconstruction are necessary to establish the preliminary proof of concept of these new strategies. Methods A rat model of rp-ACLR using a tendinous autograft after complete mid-substance ACL transection was established. Twelve weeks following surgery, clinical outcomes and knee joints were assessed through visual gait analysis, Lachman tests, thigh perimeter measurements, magnetic resonance imaging, micro-computed tomography, and histology, to evaluate the morbidity of the procedure, accuracy of bone tunnel positioning, ACL remnants fate, osteoarthritis, and autograft bony integration. Results were compared with those obtained with isolated ACL transection without reconstruction and to right non-operated knees. Results and discussion Most operated animals were weight-bearing the day following surgery, and no adverse inflammatory reaction has been observed for the whole duration of the study. Autograft fixation with cortical screws provided effective graft anchorage until sacrifice. Healing of the transected ACL was not observed in the animals in which no graft reconstruction was performed. rp-ACLR was associated with a reduced degeneration of the ACL remnants (p = 0.004) and cartilages (p = 0.0437). Joint effusion and synovitis were significantly lower in the reconstructed group compared to the transected ACL group (p = 0.004). Most of the bone tunnel apertures were anatomically positioned in the coronal and/or sagittal plane. The most deviated bone tunnel apertures were the tibial ones, located in median less than 1 mm posteriorly to anatomical ACL footprint center. Conclusion This study presents a cost-effective, new relevant and objective rat model associated with low morbidity for the preliminary study of bio-implantable materials designed for remnants-preserving ACL surgery after mid-substance ACL tear.

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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

Cited by 4 publications

References 36 publications

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

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

Refixation of the anterior cruciate ligament: A biomechanical analysis of suture techniques in a porcine model

Remnants-preserving ACL reconstruction using direct tendinous graft fixation: a new rat model

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