Re-Tensioning Technique to Cover the Graft With Remnant in Anterior Cruciate Ligament Reconstruction

Noh, Jung Ho; Yoon, Kyoung Ho; Song, Sang Jun; Roh, Young Hak

doi:10.1016/j.eats.2014.08.006

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…During the ACL reconstruction procedure, the tibial side ACL remnant would be impaired. As introduced by Ahn et al [1] and Noh et al [37] with medial traction of the remnant using sutures and with final hand reaming technique could reduce additional injury of remnant ACL tibia foot print. Seventh, the suture material used in repair was No.…”

Section: Discussionmentioning

confidence: 99%

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

Ryu

Kwon

Hong

et al. 2021

BMC Musculoskelet Disord

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Background With the developments in the arthroscopic technique, anterior cruciate ligament (ACL) remnant-preserving reconstruction is gradually gaining attention with respect to improving proprioception and enhancing early revascularization of the graft. To evaluate the mechanical pull-out strength of three different methods for remnant-preserving and re-tensioning reconstruction during ACL reconstruction. Methods Twenty-seven fresh knees from mature pigs were used in this study. Each knee was dissected to isolate the femoral attachment of ACL and cut the attachment. An MTS tensile testing machine with dual-screw fixation clamp with 30° flexion angle was used. The 27 specimens were tested after applying re-tensioning sutures with No. 0 polydioxanone (PDS), using the single stitch (n = 9), loop stitch (n = 9), and triple stitch (n = 9) methods. We measured the mode of failure, defined as (1) ligament failure (longitudinal splitting of the remnant ACL) or (2) suture failure (tearing of the PDS stitch); load-to-failure strength; and stiffness for the three methods. Kruskal-Wallis test and Mann-Whitney U-test were used to compare the variance of load-to-failure strength and stiffness among the three groups. Results Ligament failure occurred in all cases in the single stitch group and in all but one case in the triple stitch group. Suture failure occurred in all cases in the loop stitch group and in one case in the triple stitch group. The load-to-failure strength was significantly higher with loop stich (91.52 ± 8.19 N) and triple stitch (111.1 ± 18.15 N) than with single stitch (43.79 ± 11.54 N) (p = 0.002). With respect to stiffness, triple stitch (2.50 ± 0.37 N/mm) yielded significantly higher stiffness than the other methods (p = 0.001). Conclusions The results suggested that loop stitch or triple stitch would be a better option for increasing the mechanical strength when applying remnant-preserving and re-tensioning reconstruction during ACL reconstruction.

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Section: Discussionmentioning

confidence: 99%

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

Ryu

Kwon

Hong

et al. 2021

BMC Musculoskelet Disord

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“…Merter used the Cybex apparatus to measure and compare the proprioception after allogeneic and autologous ACL reconstruction, and the results showed no difference in postoperative proprioception [19]. Noh covered the graft surface with the retained ACL stump, which finally improved the healing speed of the graft, increased its strength, and improved knee joint proprioception [20]. In this study, the angle reconstruction method revealed a significant difference at 3 months and 6 months but no difference was found at 12 months, which meant that in group A, the proprioception of ACL was better than in group B.…”

Section: Discussionmentioning

confidence: 99%

Anterior cruciate ligament reconstruction using an anterior cruciate ligament stump.

Chen

Wang

2019

Videosurgery and Other Miniinvasive Techniques

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IntroductionAnterior cruciate ligament (ACL) injury always leads to knee pain and dysfunction for which surgical reconstruction is recommended, with good clinical results, but decreased postoperative proprioception also tends to occur. ACL stump (ACLS)-retaining ACL reconstruction and non-ACLS-retaining ACL reconstruction are the two surgical options.AimTo investigate the efficacy of retaining the ACLS in allograft reconstruction.Material and methodsThirty patients were retrospectively assigned to group A, ACLS-retaining ACL reconstruction; and group B, non-ACLS-retaining ACL reconstruction, and their data were analyzed. The knee function (Lysholm score and Tegner motion score) and proprioceptive function of the two groups were assessed and compared by postoperative reconstruction angle.ResultsThe 30 patients were followed up for a mean 20 months. The mean Lysholm score in group A increased from 55.7 ±11.6 points preoperatively to 95.2 ±5.7 points postoperatively; that in group B increased from 56.7 ±11.3 points preoperatively to 94.6 ±7.2 points postoperatively. The mean Tegner motion score in group A was increased from 2.4 ±0.7 points preoperatively to 6.0 ±0.7 points postoperatively; that in group B increased from 2.73 ±0.96 points preoperatively to 6.24 ±0.48 points postoperatively; the postoperative scores did not differ significantly between the two groups. The proprioception was better in group A than in group B at 3, 6, and 12 months postoperatively (p < 0.05).ConclusionsACLS-retaining ACL reconstruction has good efficacy and the retained ACLS can benefit postoperative proprioception recovery at an early stage.

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“…3,13 In addition, method modifications include positioning the graft as “behind the remnant” 23,24 and retensioning. 25,26 A previous study reported that the remnant tensioning is simple and preserves more remnant; 2 however, its method has not been developed for different femoral fixations, such as the use of an interference screw. Therefore, we modified the tensioning method to include direct suturing to the intra-articular part of the graft.…”

Section: Introductionmentioning

confidence: 99%

Remnant preservation with tensioning can improve the clinical outcome after anterior cruciate ligament reconstruction

Suh¹,

Yeo²,

Han

et al. 2022

J Orthop Surg (Hong Kong)

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Background Many studies exist about remnant preservation in anterior cruciate ligament (ACL) reconstruction. However, concern remains for development of a cyclops lesion during remnant preservation. To prevent this, a tensioning method has been suggested. Current study evaluated the clinical and radiologic results of remnant preservation in ACL reconstruction with tensioning compared to classical ACL reconstruction. Methods From January 2016 to June 2017, ACL reconstruction patients who underwent magnetic resonance imaging (MRI) 2 years postoperatively were enrolled. For comparison, all participants were divided in two groups: remnant preservation with tensioning (group R) and controls (group C). Clinically, Hospital for Special Surgery (HSS), International Knee Documentation Committee (IKDC), Lysholm scores, and incidence of symptomatic cyclops lesions were evaluated. Radiologically, signal-to-noise quotient (SNQ) and size of the synovium on MRI as well as anterior instability in Telos stress radiographs were evaluated. Results A total of 64 patients were enrolled (42 in group R and 22 in group C). The IKDC score in group R (70) was better than that in group C (62; p < 0.05). One patient in group R had a cyclops lesion with clinical symptoms and arthroscopic excision was recommended. Radiologically, the SNQ, synovium area, and anterior instability on Telos radiography showed no difference between the two groups. Conclusion Remnant preservation with tensioning is a good option for ACL reconstruction without the development of a cyclops lesion.

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Re-Tensioning Technique to Cover the Graft With Remnant in Anterior Cruciate Ligament Reconstruction

Cited by 6 publications

References 16 publications

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

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

Anterior cruciate ligament reconstruction using an anterior cruciate ligament stump.

Remnant preservation with tensioning can improve the clinical outcome after anterior cruciate ligament reconstruction

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