Roles of ACL remnants in knee stability

Nakase, Junsuke; Toratani, Tatsuhiro; Kosaka, Masahiro; Ohashi, Yoshinori; Tsuchiya, Hiroyuki

doi:10.1007/s00167-012-2260-7

Cited by 47 publications

(35 citation statements)

References 23 publications

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“…Based on arthroscopy, it is however possible to differentiate partial tears (the antero-medial bundle being more often concerned than the posterolateral one) from complete ACL lesions presenting either as a totally resorbed ligament or as a healed remnant on the intercondylar notch or the PCL [78]. These different lesions influence the SSD observed in anterior and rotational knee laxity measurements [76,[79][80][81][82]. As such, only considering complete tears to evaluate the diagnostic performance of an arthrometer cannot reflect its true diagnostic capacity.…”

Section: Further Considerations For Diagnosismentioning

confidence: 99%

Objective measurements of static anterior and rotational knee laxity

Mouton

Theisen

Seil

2016

Curr Rev Musculoskelet Med

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Several devices allow to measure anterior and rotational static knee laxity. To date, the use of rotational laxity measurements in the daily clinical practice however remains to be improved. These measurements may be systematically integrated to the follow-up of knee injuries. Physiologic laxity measurements may particularly be of interest for the identification of risk factors in athletes. Furthermore, knee laxity measurements help to improve the diagnosis of knee soft tissue injuries and to follow up reconstructions. Further prospective follow-ups of knee laxity in the injured/reconstructed knees are however required to conclude on the best treatment strategy for knee soft tissue injuries.

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Section: Further Considerations For Diagnosismentioning

confidence: 99%

Objective measurements of static anterior and rotational knee laxity

Mouton

Theisen

Seil

2016

Curr Rev Musculoskelet Med

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“…Crain et al 2 reported that there were no changes in the anteroposterior laxity of the knee after remnant debridement for cases with absent or PCL-adhering remnants, whereas cases with roof-or wall-adhering remnants showed increased instability after debridement. Nakase et al 6 reported that cases with the remnant attached to the lateral wall affects not only the anteroposterior laxity but also the rotational stability of the knee. In addition, Nakamae et al 7 reported that there was increased laxity for those who underwent remnant removal within 1 year of injury.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Remnant-Preserving Double-Bundle ACL Reconstruction With a New Remnant Augmentation Technique

Tensho

Iwaasa

Shimodaira

et al. 2020

Arthroscopy Techniques

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Anterior cruciate ligament (ACL) remnant preservation techniques have been recently introduced for covering the graft with remnant to improve the clinical results of ACL reconstruction. Several theoretical advantages exist for this technique; however, clinical results remain inconsistent and controversial. We have focused on the biomechanical function of the remnant and have been performing a new remnant-preserving reconstruction procedure that augments the graft with residual remnant. Preserving the structure and continuity of good-quality remnants may help maintain the early postoperative stress on the tendon graft, thereby providing a positive effect on remodeling. Although our concept is significantly different from previously reported remnant preservation techniques and has several pitfalls, the surgical technique that we outline in this report is simple and does not require specialized equipment. The procedure will also work more advantageously in preserving the residual mechanoreceptors in the remnant. We believe that this method can be a procedure with better results for patients with remnants that are in good condition.

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“…Proprioception is a key factor in maintaining the stability of the knee joint against functional de ciencies after ACL reconstruction. Many mechanoreceptors known to be distributed in ACL and remnant tissues contribute to the proprioceptive function of the knee [13,14]. Some previous studies have reported the presence of mechanoreceptors in ACL remnants after ACL reconstruction with the remnant preservation technique [5,15,16,17].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have evaluated proprioception, as well as the function of mechanoreceptors in reconstructed ACLs [5,10,13,14,15,16,17]. However, it is di cult to compare outcomes between these studies because of variations in the experimental methods and other external factors.…”

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of neural elements in a rat model using nerve growth factor after remnant-preserving anterior cruciate ligament reconstruction: a histological and immunofluorescence pilot study

Lee

Cho

Song

et al. 2020

Preprint

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Abstract Background: Immunofluorescence analyses of anterior cruciate ligament (ACL) allografts following remnant-preserving ACL reconstruction using Achilles tendon allografts have provided evidence for the presence of neural elements. In this study, we aimed to examine the expression of neural elements and quantify the presence of neural cells in ACL remnants and Achilles allografts using nerve growth factor (NGF) therapy after remnant-preserving ACL reconstruction.Methods: Experiments were conducted on 5 pairs of rats (approximately 8 weeks old and weighing 320 g at the time of surgery). Longitudinally split Achilles tendons from the paired rats were freshly frozen and later defrosted with warm saline and allografted onto the right ACL of the other rat that was partially detached at the femoral attachment site. A sham operation was conducted on the left knee to be used as a control. NGF was injected into both knee joints every week for 6 weeks after surgery. The presence of neural cells in the ACL of the sham-operated knee, allografted Achilles tendon, and ACL remnant was examined 6 weeks post-surgery using H and E and immunofluorescent staining.Results: H and E staining did not reveal neural cells in any of the three groups. However, immunofluorescence analysis showed the presence of nestin-positive neural elements in the normal ACL tissues as well as ACL remnants. Additionally, neural elements were examined in 7 of the 8 (87.5%) allograft tissues. Quantitative analysis showed no difference in the number or area of nuclei among the three groups. However, the number and area of neural cells in the Achilles allografts were significantly lower than those in the other two groups (p=0.000 and p=0.001, respectively).Conclusion: Our observations indicate that ACL remnants promote the new ingrowth and persistence of neural cells. We suggest that the ingrowth of neural elements can support the persistence and new ingrowth of mechanoreceptors, thereby enhancing the functional stability of knee joints. Moreover, the expression of neural cells in the Achilles allografts was lower than that in normal ACL tissues and ACL remnants in the quantitative evaluation, thereby confirming the essential role of ACL remnants in knee joint functionalization.

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Roles of ACL remnants in knee stability

Abstract: Prognostic study, level II.

Cited by 47 publications

References 23 publications

Objective measurements of static anterior and rotational knee laxity

Objective measurements of static anterior and rotational knee laxity

Anatomical Remnant-Preserving Double-Bundle ACL Reconstruction With a New Remnant Augmentation Technique

Quantitative assessment of neural elements in a rat model using nerve growth factor after remnant-preserving anterior cruciate ligament reconstruction: a histological and immunofluorescence pilot study

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