Remnant-Tensioning Single-Bundle Anterior Cruciate Ligament Reconstruction Provides Comparable Stability to and Better Graft Vascularity Than Double-Bundle Anterior Cruciate Ligament Reconstruction in Acute or Subacute Injury: A Prospective Randomized Controlled Study Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging

Kim, Jun Ho; Oh, Eunsun; Yoon, Young Cheol; Lee, Do Kyung; Lee, Sung-Sahn; Wang, Joon Ho

doi:10.1016/j.arthro.2020.08.035

Cited by 10 publications

(21 citation statements)

References 54 publications

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“…This concept has led to increased interest in studies of remnant preservation, proven by the recent surge in publications in the field of repair and remnant preservation. 2 , 3 , 6 , 7 , 8 , 12 Because of newer information about the remnant, ACL is now considered as an organ with neural and vascular tissues and not merely a stabilizing structure. 11 Many histologic studies have confirmed that remnants of torn ACL retain vascularized synovial sheets, numerous fibroblasts and myofibroblasts, and various mechanoreceptors.…”

Section: Discussionmentioning

confidence: 99%

“… 11 Many histologic studies have confirmed that remnants of torn ACL retain vascularized synovial sheets, numerous fibroblasts and myofibroblasts, and various mechanoreceptors. 2 , 3 , 12 Because of these components, preserving remnants while doing ACL reconstruction has been shown to promote early vascularization, synovialisation, and ligamentization. As these remnants are rich with mechanoreceptors, remnant preserved ACL reconstruction are also found to be regaining early proprioceptive control.…”

Section: Discussionmentioning

confidence: 99%

“… 2 Therefore, remnant-preserving ACL reconstruction has been noted to have better healing and functional results compared with remnant-sacrificing ACL reconstruction. 3 Most of these ACL tears are from femoral sides, so the remnant tends to fall anteriorly into the notch and may lead to loss of extension and cyclops lesion if preserved. 4 One of the techniques to avoid the fallback of remnants is to tension this remnant with sutures.…”

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confidence: 99%

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Remnant Tensioning Through Pullout Sutures From the Femoral Tunnel During Anatomic Anterior Cruciate Ligament Reconstruction

Joshi

Basukala

Singh

et al. 2021

Arthroscopy Techniques

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Even after anterior cruciate ligament (ACL) tear, its remnant retains the vascularized synovial sheets, fibroblasts, myofibroblasts, and various mechanoreceptors within it. The aim of preserving the remnant is to retain these components during ACL reconstruction. In the recent past, there has been an increasing trend towards preserving remnants during ACL reconstruction. Although preserving remnants have physiological advantages, cyclops lesion and extension loss were among the most feared complications. Cyclops and loss of extension are due to the fallback of the remnant into the notch. Moreover, the mechanoreceptors present in the remnant are not active when the remnant is lax. These mechanoreceptors are active when the remnant is in tension. Thus, rather than merely preserving the remnant, it is essential to tension it for more physiological functions. Although there are various techniques of remnant tensioning described in the literature, these techniques require tampering of the fixation devices or an extra fixation device adding to the cost of surgery. We describe our modification of the remnant-tensioning method during anatomic ACL reconstruction. In this technique, the sutures holding the remnant are pulled out through the anatomic femoral tunnel and fixed with an interference screw along with the hamstring graft. This technique is cost-effective, reproducible, and does not require tampering with the fixation devices. Moreover, the direction of remnant pull will be the same as that of the reconstructed graft making both the graft and remnant anatomical in orientation. Suture management and visibility of the intraarticular structures during this procedure are a few downsides of this technique. The only prerequisite of this technique is a good quality remnant to hold the sutures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Remnant Tensioning Through Pullout Sutures From the Femoral Tunnel During Anatomic Anterior Cruciate Ligament Reconstruction

Joshi

Basukala

Singh

et al. 2021

Arthroscopy Techniques

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“…To maximize ACL remnant tissue preservation (RTP) at the time of TT-SB ACL reconstruction, 15 we developed RTP behind the resident’s ridge TT-SB ACL reconstruction. This Technical Note aims to guide surgeons through the appropriate use of this technique using an offset guide (Smith & Nephew Endoscopy, Andover, MA).…”

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confidence: 99%

Remnant Tissue Preserved Transtibial Anterior Cruciate Ligament Reconstruction With Femoral Tunnel Created Behind the Resident’s Ridge

Takahashi¹,

Takeshita

2021

Arthroscopy Techniques

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Although the transtibial (TT) technique for single-bundle (SB) arthroscopic anterior cruciate ligament (ACL) reconstruction has been widely used, surgeons often disadvantageously create the femoral bone tunnel at the arthroscopically noon position, which is alleged the "ACL isometric point," when the femoral bone tunnel could be created behind the resident's ridge with TT-SB ACL reconstruction by paying attention to the location of the tibial tunnel inlet and the angle of tibial tunnel. This alternative approach preserves ACL remnant tissue, which might contribute to better postoperative remodeling and regeneration of proprioceptive mechanoreceptors. This technique reduces surgical invasiveness and can enhance postoperative graft remodeling and proprioceptive recovery. To successfully use the devices required for this procedure, surgeons must understand the proper techniques. Hence, this technical note aims to demonstrate TT-SB ACL reconstruction with remnant tissue preservation.

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“…Bearing in mind this caveat, from our point of view, surgical techniques are frequently modified, but most modifications do not "completely" change how we operate. For example, "new" ACL techniques, such as double-bundle, 3 anatomic, 4 all-inside, 5 or new graft options, 5 or preparation methods, 6 seem like refinement rather than disruption. "New" soft tissue-to-bone fixation implants, such as those used in shoulder surgery, may allow us to operate with greater facility, but have not "completely" changed what we accomplish.…”

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confidence: 99%

Medical Journals Should Be a Forum for Disruptive Research

Hohmann¹,

Lubowitz²,

Brand³

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Disruptive innovation completely changes the traditional way that we operate and may only be realized in retrospect. For example, shoulder superior capsule reconstruction (SCR) is a complete change from the traditional methods of treating massive, irreparable rotator cuff tears and pseudoparalysis. Classic examples of disruptions in orthopaedic surgery include distraction osteogenesis, total hip joint replacement arthroplasty, and modern orthopaedic trauma care. Orthopaedic technologies that promise future disruption include artificial intelligence, surgical simulation, and orthopaedic biologics, including mesenchymal stromal cell (MSC) and gene therapy. Most of all, arthroscopic surgery completely changed the way we operate by using new methods and technology. Many never saw it coming. The challenge going forward is to motivate and foster new ideas and research that result in innovation and progress. Skepticism has a place, but not at the expense of transformative ideas, particularly as medical journals offer the alternative of prospective hypothesis testing using the scientific method, followed by unbiased peer review, and publication. Medical journals should be a forum for disruptive research.

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Cited by 10 publications

References 54 publications

Remnant Tensioning Through Pullout Sutures From the Femoral Tunnel During Anatomic Anterior Cruciate Ligament Reconstruction

Remnant Tensioning Through Pullout Sutures From the Femoral Tunnel During Anatomic Anterior Cruciate Ligament Reconstruction

Remnant Tissue Preserved Transtibial Anterior Cruciate Ligament Reconstruction With Femoral Tunnel Created Behind the Resident’s Ridge

Medical Journals Should Be a Forum for Disruptive Research

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