Clinical and arthroscopic outcome of single bundle anterior cruciate ligament reconstruction: Comparison of remnant preservation versus conventional technique

Choi, Sung Wook; Kim, Myung-Ku; Kwon, Yong Suk; Kang, Hyunseong

doi:10.1016/j.knee.2017.05.012

Cited by 15 publications

(9 citation statements)

References 26 publications

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“…During arthroscopic knee surgery, flushing the site with saline irrigation often is necessary to clear the surgical field and improve visualization. Fluids such as normal saline, lactated Ringer’s solution, and carbohydrate solutions typically are used for irrigation to expand the joint and provide visibility sufficient that the procedure can continue [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Temperature and Volume of Intraoperative Normal Saline Irrigation on Postoperative Pain, Swelling, and Serum Markers of Inflammation in Patients After Elective, Arthroscopic, Single-Bundle Surgical Reconstruction of the Anterior Cruciate Ligament: A Retrospective, Single-Center Study

et al. 2021

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Background Arthroscopic single-bundle surgical reconstruction of the anterior cruciate ligament (ACL) is often performed electively after 3 weeks of mobilization therapy. The present single-center retrospective study aimed to investigate the effects of temperature and volume of intraoperative normal saline irrigation on postoperative pain and swelling and on serum markers of inflammation following elective, arthroscopic, single-bundle surgical reconstruction of the ACL. Material/Methods Clinical data from 716 patients with non-acute ACL injuries who met the criteria between March 2015 and May 2020 were retrospectively analyzed. The patients were broken into 5 groups, depending on the volume or temperature of intraoperative irrigation with normal saline. At specific times after surgery, pain, knee swelling, and skin temperature were assessed. Postoperative levels of serum C-reactive protein (CRP), interleukin (IL)-1, IL-6, and IL-10 also were measured. Results Visual analog scale (VAS) scores for pain, rates of swelling, and skin temperature differed significantly among the 5 groups at all postoperative time points ( P <0.001). The VAS scores( P =0.322) and ratings for swelling ( P =0.245), and skin temperature ( P =0.093) were not significantly different among the volume groups. There were no significant differences in the VAS scores ( P =0.055), swelling ratings ( P =0.570), or skin temperatures ( P =0.321) among the groups that received irrigation with normal saline at different temperatures. There were no significant differences in postoperative serum levels of CRP, IL-1, IL-6, or IL-10 among the groups ( P >0.05). Conclusions Irrigation with different volumes and temperatures of normal saline did not have a significant effect on postoperative pain, swelling, or serum markers of inflammation.

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Section: Discussionmentioning

confidence: 99%

Effects of Temperature and Volume of Intraoperative Normal Saline Irrigation on Postoperative Pain, Swelling, and Serum Markers of Inflammation in Patients After Elective, Arthroscopic, Single-Bundle Surgical Reconstruction of the Anterior Cruciate Ligament: A Retrospective, Single-Center Study

et al. 2021

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“…Synovial coverage of the graft was also mostly categorized into three categories, while the criteria for classification varied by study. Some studies regarded the best category as complete coverage [6,7,18,28,30], but a few other studies classified it as more than 80% [8,10,32,33] or 50% [24] and some other studies as more than 20% [14]. This seems to be influenced by the subjective philosophy of each surgeon as to how much synovial coverage is considered good.…”

Section: Discussionmentioning

confidence: 99%

“…Among the studies that classified synovial coverage into two categories, Otsubo et al [23] referred to more than 50% of synovial coverage as normal, but Yoo et al [14] considered more than 20% of synovial coverage as good. Some studies used two [14,22,24] or four categories [9,33,34] to evaluate the synovial coverage of the graft.…”

Section: Synovial Coverage Of Graft On Second-look Arthroscopymentioning

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

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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.

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“…However, in the period of tissue necrosis and new tissue ingrowth, the graft failure load is significantly reduced and it is easy to damage again. A large number of biological and animal experiments have shown that the preservation of ACL remnant can accelerate the synovial coverage of the transplanted ligament, reduce synovial fluid invasion of the transplanted ligament and the inner wall of the bone tunnel, and promote revascularization, ligamentization, and tendon-bone healing (7)(8)(9)(10). Beside, residual proprioceptors in the ACL remnant still play a role in stabilizing the knee after ACL injury (11).…”

Section: Introductionmentioning

confidence: 99%

Effects of remnant preservation in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

Xie

Zhong

et al. 2022

Front. Surg.

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BackgroundCompared with standard anterior cruciate ligament (ACL) reconstruction, it is controversial whether anterior cruciate ligament reconstruction (ACLR) with remnant preservation can lead to better clinical outcomes. We conducted a systematic study and meta-analysis to assess the differences in clinical efficacy between the two.MethodWe searched for clinical randomized controlled studies and cohort studies included in the Cochrane library, PubMed, and Embase from March 2012 to March 2022 in English. The included studies were ACLR with or without remant preservation, and the data were extracted and the quality of the included studies was assessed by two authors, respectively. Revman 5.4 was used for statistical analysis and conclusions were presented.ResultTen articles containing a total of 777 patients were finally included. There was no significant difference in postoperative Lachman test [OR = 1.66, 95%CI (0.79, 3.49), P = 0.18 > 0.05], Tegner score [SMD = −0.13, 95%CI (−0.47, 0.22), P = 0.46 > 0.05], synovial coverage rate by second-look arthroscopy [OR = 1.55, 95%CI (0.66, 3.65), P = 0.32 > 0.05], the rate of cyclops lesion [OR = 3.92, 95%CI (0.53, 29.29), P = 0.18 > 0.05], joint range of motion [SMD = 0.27, 95%CI (−0.13, 0.68), P = 0.19 > 0.05] and re-injury rate [OR = 0.57, 95%CI (0.18, 1.74), P = 0.32 > 0.05] between the two groups. There were statistically significant differences in postoperative Lysholm score [SMD = 0.98, 95% CI (0.32, 1.64), P = 0.004 < 0.05], International Knee Documantation Committee grade (IKDC grade) [OR = 2.19, 95%CI (1.03, 4.65), P = 0.04 < 0.05], Pivot shift test [OR = 1.71, 95%CI (1.06, 2.77), P = 0.03 < 0.05], KT1000/2000 arthrometer side-to-side difference [SMD = −0.22, 95%CI (−0.42, −0.03), P = 0.02 < 0.05], operation time [SMD = 11.69, 95%CI (8.85, 14.54), P = 0.00001 < 0.05] and degree of tibial tunnel enlargement [SMD = −0.66, 95%CI (−1.08, −0.23), P = 0.002 < 0.05].ConclusionThis meta-analysis concluded that remnant preservation significantly had better results in terms of patient functional score (Lysholm, IKDC), knee stability (Pivot shift test, postoperative side-to-side anterior laxity) and tibial tunnel enlargement. In terms of complications (incidence of Cyclops lesions, range of motion, re-injury rate), no significant differences were seen between the two groups. Although many studies concluded that remnant preservation could bring better synovial coverage, this meta-analysis indicated that there is insufficient evidence to support it, possibly due to different remnant preservation procedures.The potential risks associated with longer operation times are also worth considering.

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Clinical and arthroscopic outcome of single bundle anterior cruciate ligament reconstruction: Comparison of remnant preservation versus conventional technique

Cited by 15 publications

References 26 publications

Effects of Temperature and Volume of Intraoperative Normal Saline Irrigation on Postoperative Pain, Swelling, and Serum Markers of Inflammation in Patients After Elective, Arthroscopic, Single-Bundle Surgical Reconstruction of the Anterior Cruciate Ligament: A Retrospective, Single-Center Study

Effects of Temperature and Volume of Intraoperative Normal Saline Irrigation on Postoperative Pain, Swelling, and Serum Markers of Inflammation in Patients After Elective, Arthroscopic, Single-Bundle Surgical Reconstruction of the Anterior Cruciate Ligament: A Retrospective, Single-Center Study

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

Effects of remnant preservation in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

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