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

Abstract

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.

Is Remnant Preservation in Anterior Cruciate Ligament Reconstruction Superior to the Standard Technique? An overview of systematic reviews

“…According to the above search strategy, 130 related literatures were initially retrieved,32 duplicate literatures were excluded by using the literature management software Endnote X9, 78 unrelated literatures were excluded by reviewing the title and abstract, and 6 literatures were excluded by reading the full text of the literature. Finally, 14 literatures were included (19,21,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). The speci c literature retrieval and exclusion process is shown in Fig.…”

“…Of the 14 SRs, 9 SRs were rated as critically Low quality. (19,30,32,(34)(35)(36)(37)(38)40), 5 SRs were rated as low quality. (21,29,31,33,39) The results of the methodological quality assessment using the AMSTAR 2 tool are shown in…”

“…Four of the original research literatures included in SR were RCTs (21,(29)(30)(31). All 14 SRs assessed the risk of bias of the included original studies, and one SR used PEDro (29), 1 SR using JADAD scale (35), 1 SR using the modi ed Coleman methodology score(CMS) (19), 1 SR using the ROBINS-I(34), 1 SR using the Newcastle-Ottawa scale (33), 1 SR using the Newcastle-Ottawa scale NOS and Cochrane bias risk assessment tool (32), Other SRs used the Cochrane Collaboration bias risk assessment tool (21,30,31,(37)(38)(39)(40). All 14 SRs included meta-analysis, and 6 SRs included sensitivity analysis (21,29,31,35,39,40), 7 SRs included subgroup analysis (19, 29, 31-33, 35, 39), Postoperative adverse reactions and complications were reported in 12 SRs (19, 21, 29-33, 35-38, 40), 6 SRs assessed publication bias (21,29,31,33,34,39), Sources of funding were reported in 7 SRs (29,32,(35)(36)(37)(38)40).…”

“…At the same time, only two SRs reported a complete search strategy for a database, and reported other literature collection methods in addition to searching electronic databases (31,36). Most SRs did not report the risk of bias for research and additional analysis well, and only 7 SRs reported sources of funding and other funding (29,32,(35)(36)(37)(38)40). The PRISMA checklist for all SRs is shown in Table 4 and Fig.…”

Comparative Study of Graft Healing in 2 Years after “Tension Suspension” Remnant-Preserving and Non-Remnant-Preserving Anatomical Reconstruction for Sherman Type II Anterior Cruciate Ligament Injury

“…Recently, the preservation of the remnant of the ACL has become a hot spot in the treatment of anterior cruciate injuries, and there are different opinions on whether to preserve the remnant of the ACL. Some scholars believe that it contains a large number of residual blood vessels and various tissue cells, and can provide the required nutritional support and a favorable growth environment for the tendon-bone interface after ACL reconstruction, and the residual proprioceptors in it have a good effect on the proprioceptive recovery and functional recovery of the knee joint [ 5 , 6 , 7 ]. However, some authors believe that the residual tissue can produce inflammatory factors that can adversely affect the prognosis of the surgery and have an influence on the intraoperative positioning of the graft, which can be negative for the healing of the tendon-bone after surgery [ 8 , 9 , 10 ].…”