Arthroscopic Evaluation of Preserved Ligament Remnant After Selective Anteromedial or Posterolateral Bundle Anterior Cruciate Ligament Reconstruction

Ohsawa, Takashi; Kimura, Masashi; Kobayashi, Y.; Hagiwara, Kaoru; Yorifuji, Hiroshi; Takagishi, Kenji

doi:10.1016/j.arthro.2011.11.033

Cited by 45 publications

(27 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Correct evaluation of the graft remnant is challenging. Ohsawa et al 21 reported that it is difficult for even a skilled arthroscopic surgeon to determine the efficacy of the residual bundle, which can be taut, slightly lax, or lax. Performing anatomic reconstruction of only 1 bundle with an associated underestimated inefficacy of the graft remnant may risk failure.…”

Section: Discussionmentioning

confidence: 99%

“…The graft cannot be placed in the 10-o'clock position (for a right knee) because of the presence of the residual anteromedial band; therefore, the reconstructed bundle is more vertical, bridging and tensioning the residual anteromedial band. The posterolateral band has been proven to be important when the knee is subjected to combined rotatory loads, such as those produced in a pivot shift, and especially with the knee near full extension 15,[19][20][21][22] ; reconstruction of this bundle in the correct position is advisable. The current authors accepted this drawback of the nonanatomic augmentation technique because in partial ACL tears, the rotatory instability is minimal or absent (the pivot shift test is always negative or only trace positive), 19 so reconstruction of the posterolateral band with the graft at the 10-o'clock position is not strictly required in these cases.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Partial ACL Tears: Anatomic Reconstruction Versus Nonanatomic Augmentation Surgery

Buda¹,

Ruffilli²,

Parma³

et al. 2013

Orthopedics

View full text Add to dashboard Cite

Treatment of partial anterior cruciate ligament (ACL) tears requires ACL remnant preservation. The goal of this study was to compare the outcome of anatomic reconstruction of the torn bundle with nonanatomic augmentation using the over-the-top femoral route. Fifty-two athletes (mean age, 23.3 years) with partial ACL lesions underwent anatomic reconstruction (n=26) or nonanatomic augmentation (n=26). Intraoperative damage of the healthy bundle that required a standard ACL reconstruction occurred in 2 patients in the anatomic reconstruction group. International Knee Documentation Committee (IKDC) score, Tegner score, and arthrometer evaluation were used pre-operatively and at follow-up for up to 5 years postoperatively. One failure occurred in the anatomic reconstruction group. Mean IKDC subjective score at follow-up was 88.2 ± 5.7 in the anatomic reconstruction group and 90.2 ± 4.7 in the nonanatomic augmentation group. According to the IKDC objective score at final follow-up, 96% of knees in the nonanatomic augmentation group were normal vs 87.5% in the anatomic reconstruction group. No significative differences were observed between the 2 groups at final follow-up. Anteromedial bundle reconstruction showed significantly lower IKDC subjective and objective scores and higher residual instability values as evaluated with the arthrometer compared with posterolateral bundle reconstruction (P=.017). The surgical treatment of ACL partial tears is demanding. Adapted portals, perfect control of the tunnel drilling process, and intercondylar space management are required in anatomic reconstruction. The nonanatomic augmentation technique is simpler, providing excellent durable results over time with a lower complication rate. Anteromedial bundle reconstruction is associated with a poorer outcome, especially when performed with anatomic reconstruction.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Partial ACL Tears: Anatomic Reconstruction Versus Nonanatomic Augmentation Surgery

Buda¹,

Ruffilli²,

Parma³

et al. 2013

Orthopedics

View full text Add to dashboard Cite

show abstract

“…1). All studies except one [19] were from northeast Asian regions including South Korea [6, 9-11, 14, 20, 22, 24, 26, 27, 31, 33], Japan [5,7,8,12,13,17,21,23,25,[28][29][30]32], and China [18,34]. Year of publication ranged from 1994 to 2017.…”

Section: Study Identification and Characteristicsmentioning

confidence: 99%

Evaluation parameters of graft maturation on second-look arthroscopy following anterior cruciate ligament reconstruction: a systematic review

Kim

Jung

Song

et al. 2019

Knee Surg & Relat Res

View full text Add to dashboard Cite

Purpose: The purpose of this systematic review was to investigate and summarize the evaluation methods of graft maturation on second-look arthroscopy following anterior cruciate ligament (ACL) reconstruction. Methods: A literature search was performed on articles before December 2017 to identify the literature that has evaluated graft maturation on second-look arthroscopy following ACL reconstruction. Only studies using human grafts, evaluating graft maturation with two or more gross findings were included. Study design, grafts, surgical techniques, follow-up period, evaluation parameters, and categories were compiled. Results: Twenty-eight studies were included in this study. All studies evaluated graft maturation with two or more of the following three findings: graft integrity, tension, and synovial coverage. Two to four categories were used for evaluating each parameter, but the criteria for classification were slightly different for each study. Several studies reported neo-vascularization of grafts and the total maturation score by summing up the scores assigned to each evaluation parameter. Three studies reported that there was no correlation between second-look findings and patient-reported outcomes. Conclusions: Graft integrity, tension, and synovial coverage were the most frequently evaluated for graft maturation on second-look arthroscopy. However, there is no uniform criterion for evaluation. Therefore, development of a valid, uinform criterion is required. Level of evidence: Level IV, systematic review of level I-IV investigations.

show abstract

“…Because the two functional ACL bundles, the anteromedial (AM) and the posterolateral (PL) bundles [6,22,31], have different tension patterns according to the flexion angle of the knee [19,30], each bundle of the ACL may show a different rupture pattern according to the injury mechanism [34]. Accordingly, there may be isolated ACL bundle injuries that can be candidates for selective bundle reconstruction [1,22] while preserving the uninjured bundle [3,9,15,32].…”

Section: Introductionmentioning

confidence: 99%

“…This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital, Seoul, Korea. theoretical benefit of preserving remnant tissue of ACL, the remnant preservation technique and/or selective bundle reconstruction have received increased attention [3,12,14,15,24]. Because the two functional ACL bundles, the anteromedial (AM) and the posterolateral (PL) bundles [6,22,31], have different tension patterns according to the flexion angle of the knee [19,30], each bundle of the ACL may show a different rupture pattern according to the injury mechanism [34].…”

Section: Introductionmentioning

confidence: 99%

How Useful Is MRI in Diagnosing Isolated Bundle ACL Injuries?

Chang

Choi

et al. 2013

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Selective bundle anterior cruciate ligament (ACL) reconstruction and/or remnant ACL preservation may be reasonable options for some patients. However, the frequency of isolated anteromedial (AM) or posterolateral (PL) bundle injuries in patients undergoing ACL reconstruction is unknown, and the value of MRI for prediction of this injury pattern is likewise unknown. Questions/purposes We sought to determine (1) the proportion of knees with an intact AM or PL bundle in patients undergoing ACL reconstruction; (2) whether MRI predicted the bundle conditions seen at the time of surgery; and (3) whether the accuracy of the MRI prediction was affected by the timing of MRI after injury. Methods During primary ACL reconstructions of 156 knees, conditions of AM and PL bundles were separately examined and classified into three categories: (1) completely torn; (2) attenuated; and (3) intact. Then, the bundles were assessed by blinded observers on MRI and classified into the corresponding three categories for 77 patients who had an MRI at our institution using a standard protocol. Diagnostic accuracy of MRI was computed, and the early MRI group (B 6 weeks from injury to MRI acquisition) was compared with the late MRI group ([6 weeks). Results Only 11 (7%) of the 156 knees we treated had an intact AM (one knee) or PL bundle (10 knees). Another 55 knees (35%) had a structurally continuous but attenuated AM or PL bundle. The overall diagnostic accuracy of MRI was 83%; accuracy was better for the AM bundle than the PL bundle (91% versus 78%; p = 0.026). MR prediction was less accurate in the early MRI group, particularly for PL bundle injury.

show abstract

Arthroscopic Evaluation of Preserved Ligament Remnant After Selective Anteromedial or Posterolateral Bundle Anterior Cruciate Ligament Reconstruction

Cited by 45 publications

References 33 publications

Partial ACL Tears: Anatomic Reconstruction Versus Nonanatomic Augmentation Surgery

Partial ACL Tears: Anatomic Reconstruction Versus Nonanatomic Augmentation Surgery

Evaluation parameters of graft maturation on second-look arthroscopy following anterior cruciate ligament reconstruction: a systematic review

How Useful Is MRI in Diagnosing Isolated Bundle ACL Injuries?

Contact Info

Product

Resources

About