Outcome Differences of Remnant- Preserving versus Non-Preserving Methods in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-analysis with Subgroup analysis

Won, Sung Hun; Lee, Byung-Il; Park, Suyeon; Min, Kyung-Dae; Kim, Jun-Bum; Kwon, Sai-Won; Kim, Yong-Beom; Seo, Gi-Won; Kim, Jae-Hyung; Choi, Hwan Jun

doi:10.1186/s43019-019-0017-z

Cited by 17 publications

(17 citation statements)

References 26 publications

(78 reference statements)

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“…The ACL's primary function is to maintain mechanical stability of the knee joint. However, several studies have failed to show a superior result with remnant preservation in terms of mechanical stability compared with standard ACLR 23 , 27 , 28 . The present study demonstrated a consistent conclusion that the parameters of the two groups on mechanical stability, tested by the KT2000 arthrometer at different angles and force, were equivalent.…”

Section: Discussionmentioning

confidence: 99%

Proprioceptive and Clinical Outcomes after Remnant Preserved Anterior Cruciate Ligament Reconstruction: Assessment with Minimal Confounding Factors

Liu

et al. 2021

Orthopaedic Surgery

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Objective To evaluate the proprioceptive and clinical function of the knee joint after anterior cruciate ligament reconstruction (ACLR) with various amounts of remnant preserved with as few confounding factors as possible. Methods This retrospective study included 46 patients who underwent ACLR with remnant preservation between March 2013 and February 2019. These patients had less than 6 months injury‐to‐surgery interval and no concomitant injuries. The researchers divided these subjects into two groups based on the length of the remnant preserved after ACLR, with group A defined as having more than 1/3 of the original length preserved and group B defined as less than 1/3 of the original length preserved. Clinical scores were obtained using the Lysholm knee scoring scale and the Tegner activity scale. The Lysholm score was calculated preoperatively, at 3, 6, and 12 months postoperatively, and at the last follow up. The Tegner score was calculated preoperatively, at 12 months postoperatively and at the last follow up. Anterior laxity was measured using the KT2000 arthrometer preoperatively and at 12 months postoperatively. Proprioceptive function was evaluated through reproduction of passive positioning (RPP) and threshold to detection of passive motion (TDPM). Both RPP and TDPM were measured at the angle of 15° at 3, 6, and 12 months postoperatively. Unpaired t‐tests were performed to investigate the difference in each parameters between the two groups. Results In the present study, 20 patients were classified into group A and 26 into group B. All patients were followed up for an average of 34.70 ± 12.79 months. All 46 patients were satisfied with the outcome of the surgery and no complications were reported at the end of the study. No significant differences were found between the two groups in terms of the Lysholm score and anterior laxity by KT2000 at all time points. The Tegner score was significantly higher in group A at 12 months postoperatively and at the final follow‐up. In addition, group A's RPP was significantly better than that of group B's when tested at the angles of 15° and 30° at 3 months postoperatively, and at the angle of 15° at 6 months postoperatively. Group A's TDPM was also significantly better than that of group B's at all three tested angles at 3 months postoperatively, and at the angle of 15° at 6 months postoperatively. Conclusion Patients with ACLR with more than 1/3 of the original length preserved demonstrated a higher activity level 12 months postoperatively and better proprioceptive function at 15° of extension at 3 and 6 months postoperatively.

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Section: Discussionmentioning

confidence: 99%

Proprioceptive and Clinical Outcomes after Remnant Preserved Anterior Cruciate Ligament Reconstruction: Assessment with Minimal Confounding Factors

Liu

et al. 2021

Orthopaedic Surgery

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“…Therefore, as much remnant tissue as possible should be preserved in tears proximal to the RC footprint. Similarly, preservation of the remnant tissue has recently attracted attention in anterior cruciate ligament (ACL) reconstruction [ 9 , 10 ]. Besides retaining proprioceptive mechanoreceptors, preserving the remnant tissue is advantageous for enhancing revascularization and improving joint stability [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

A technique for repairing rotator cuff transtendinous tears with a remnant attached to the footprint

et al. 2021

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Background Some unusual rotator cuff (RC) tears are located in more proximal tendinous portions, with substantial remnant tissue attached to the footprint. The two options for surgical repair are sacrificing or preserving the remnant tissue. We introduce a surgical repair technique that preserves as much of the remnant footprint as possible. Surgical technique A double-loaded suture anchor is inserted into the subchondral bone at the medial portion of the RC footprint; the lateral remnant tissue is preserved. Each strand is shuttled and repassed through the medial portion of the tendon in a mattress fashion using a suture hook device. Then, multiple no. 1 PDS sutures are passed through the medial and lateral stumps and left untied. Strands from the suture anchor are first tied in a double mattress fashion. Then, the repair is completed by tying the remaining no. 1 PDS sutures. Conclusions We propose a remnant-preserving RC repair technique for transtendinous RC tears with sufficient tissue remaining within the RC footprint. This technique appears advantageous in terms of re-establishing an environment that promotes tendon healing after repair.

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“…Systematic reviews 13 , 33 , 37 stated that there was no significant difference in objective, subjective, or functional clinical outcome. A meta-analysis 40 recently reported that the Lysholm scores and IKDC subjective scores showed statistically minor differences but no significant difference in subgroup analysis. Thus, its actual clinical effectiveness is still controversial.…”

Section: Discussionmentioning

confidence: 97%

Occurrence Rate of Cyclops Lesion After Anatomic Double-Bundle ACL Reconstruction: Comparison Between Remnant Tissue Preservation and Resection Methods

Hishimura

Kondo

Suzuki

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: The occurrence rate of cyclops lesion after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with remnant tissue preservation remains unclear. Hypothesis: The study hypotheses were as follows: (1) the occurrence rate of cyclops lesion will be comparable between the remnant-preserving and remnant-resecting ACL reconstruction methods, and (2) there will be no significant differences in clinical outcomes between the remnant-preserving and remnant-resecting procedures. Methods: This retrospective comparative study involved 177 patients who underwent unilateral anatomic double-bundle ACL reconstruction using hamstring tendon autografts from 2014 to 2018 at our hospital. According to the Crain classification of ACL remnant tissue, 98 patients with remnant types I, II, or III underwent the remnant-preserving procedure (group A), and the remaining 79 patients with remnant type IV underwent the remnant-resecting procedure (group B). All patients underwent second-look arthroscopy. Patients were evaluated according to arthroscopic and clinical results at postoperative 15.2 ± 8.4 months (mean ± SD). Statistical comparisons between groups were made using the paired Student t test, chi-square test, and Fisher exact test. Study Design: Cohort study; Level of evidence, 3. Results: At second-look arthroscopy, the incidence of cyclops lesions was significantly higher in group B than in group A (29.1% vs 13.3%; P = .0139). Cyclops lesions were divided into 4 locations: femoral side (type 1), midsubstance (type 2), tibial side (type 3), and anterior (type 4) of the ACL graft. The ratio of the tibial-side cyclops lesion (type 3) was significantly higher in group B than in group A ( P = .0354). There were no significant differences in the clinical evaluation scores between the procedures. Side-to-side anterior laxity was significantly less in group A than in group B (0.7 vs 1.6 mm; P = .0035). Concerning postoperative laceration and synovium coverage of the grafts, group A was significantly better than group B ( P < .0001). Conclusion: In this cohort of patients undergoing double-bundle ACL reconstruction, resection of the ACL remnant was associated with a significantly higher rate of cyclops lesion formation when compared with preservation of the remnant.

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Outcome Differences of Remnant- Preserving versus Non-Preserving Methods in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-analysis with Subgroup analysis

Cited by 17 publications

References 26 publications

Proprioceptive and Clinical Outcomes after Remnant Preserved Anterior Cruciate Ligament Reconstruction: Assessment with Minimal Confounding Factors

Proprioceptive and Clinical Outcomes after Remnant Preserved Anterior Cruciate Ligament Reconstruction: Assessment with Minimal Confounding Factors

A technique for repairing rotator cuff transtendinous tears with a remnant attached to the footprint

Occurrence Rate of Cyclops Lesion After Anatomic Double-Bundle ACL Reconstruction: Comparison Between Remnant Tissue Preservation and Resection Methods

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