The Anterior Cruciate Ligament Remnant: To Leave It or Not?

Song, Gonghua; Zhang, Hui; Zhang, Jin; Xu, Li; Chen, Xing-Zuo; Li, Yue; Feng, Hao

doi:10.1016/j.arthro.2013.03.078

Cited by 51 publications

(40 citation statements)

References 36 publications

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“…It has been widely published that the revascularization of the tendon graft after ACL reconstruction by surgery is a crucial step in the "ligamentization" process (Arnoczky, Tarvin, & Marshall, 1982;Butler et al, 1989;Petersen et al, 2003;Yoshikawa et al, 2006). In fact, some techniques have been described trying to enhance both the revascularization and the proprioception after ACL reconstruction preserving the tibial and/or femoral stumps, which can benefit the patient (Lee, Kwon, Kim, Choi, & Min, 2008;Song et al, 2013;Nag & Gupta, 2014). Revascularization is one of the first processes that must occur for a successful integration of the tendon after ACL reconstruction (Tohyama, Yoshikawa, Ju, & Yasuda, 2009).…”

Section: Discussionmentioning

confidence: 99%

The Use of Autologous Fibroblasts for the Reconstruction of the Anterior Cruciate Ligament Tears

Guillén-García¹,

Rodríguez‐Iñigo²,

Guillén-Vicente³

et al. 2015

IJB

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Surgical reconstruction using an autologous or allogenic allograft is the treatment of choice for anterior cruciate ligament (ACL) tear repair. We have checking the treatment of ACL tears with in vitro cultured autologous fibroblasts on porcine type I/III collagen membranes, in 12 sheep randomly assigned to be treated with collagen membrane without cells or with porcine membrane plus 5 million autologous fibroblasts per cm 2 . The animals underwent a first surgery in which a biopsy of the ACL was taken, and a second one in which the membrane was implanted alone (N=6) or with the fibroblasts (N=6) isolated from the biopsy. After 16 weeks, the animals were sacrificed and samples of healthy and repaired ACL were taken for histological and gene expression of type I collagen (COL1), MMP-13 (matrix metallopeptidase 13), and tenascin-C (TNC) studies. The architecture of normal ACL was not conserved either in the ACL treated with the membrane with or without cells. However, a higher degree of peripheral vascularization was observed in the ACL treated with membrane plus fibroblasts than in those treated with membrane alone. Cellularity and nucleus volume were significantly higher in the center or the periphery of the neo-formed ACL than in the control ACL. No differences between the ACL treated with membrane alone or with membrane plus cells were observed in the relative COL1, MMP-13 and tenascin-C expression. Fibroblasts embedded in porcine type I/III membranes probably enhance vascularization of the graft, so it could be a promising tool for the treatment of ACL tears.

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Section: Discussionmentioning

confidence: 99%

The Use of Autologous Fibroblasts for the Reconstruction of the Anterior Cruciate Ligament Tears

Guillén-García¹,

Rodríguez‐Iñigo²,

Guillén-Vicente³

et al. 2015

IJB

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“…This has been summed up by 2 recently published reviews, although both of them concluded that the current level of evidence is not strong enough to conclusively prove the superiority or advantage of remnant-preserving reconstruction techniques as compared with conventional techniques. 3,4 When a continuous ACL remnant is available, its preservation has been shown to improve vascularization of the ACL graft, blood flow, ligamentization, tendon-to-bone integration, and proprioceptive function. [3][4][5][6] Such improvement has also been suggested with even tibial stump preservation in cases in which there is no continuous remnant between the femur and tibia.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 When a continuous ACL remnant is available, its preservation has been shown to improve vascularization of the ACL graft, blood flow, ligamentization, tendon-to-bone integration, and proprioceptive function. [3][4][5][6] Such improvement has also been suggested with even tibial stump preservation in cases in which there is no continuous remnant between the femur and tibia. 1,2,7,8 Morphologically normal mechanoreceptors have been shown to be present in both tibial and femoral ACL stumps biopsied during ACL reconstructions.…”

Section: Discussionmentioning

confidence: 99%

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Anterior Cruciate Ligament Reconstruction With Preservation of Femoral Anterior Cruciate Ligament Stump

Nag

Gupta

2014

Arthroscopy Techniques

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Anterior cruciate ligament (ACL) reconstruction with preservation of either the remnant or the tibial stump is performed with the hope of improving the vascularization and proprioceptive function of the graft. Remnant preservation is technically difficult because it hinders the visualization of the intra-articular tunnel site. Taking a cue from the concept of tibial stump preservation, we have modified our ACL reconstruction technique to preserve a sleeve of the soft tissue and ACL stump attached to the femoral condyle, in addition to tibial stump preservation, while still allowing adequate visualization of the femoral ACL insertion site. We describe our modification in this article and hypothesize that this should further improve graft vascularization and ligamentization.

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“…Early ACL remnantesparing techniques support the theory of preserving the proprioceptive receptors, enhancing the revascularization process, and finally, achieving "cellular ligamentization." 4 However, ACL remnanteretaining procedures can be technically demanding and predispose to cyclops lesion formation. 5 The purpose of this study is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur using a "lasso loop" reeved through the femoral EndoButton (EndoButton CL; Smith & Nephew Endoscopy, Andover, MA).…”

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confidence: 99%

Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

Boutsiadis

Karampalis

Tzavelas

et al. 2015

Arthroscopy Techniques

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Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnantesparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a "lasso-loop" technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device.A nterior cruciate ligament (ACL) rupture is one of the most common knee injuries, predisposing to altered knee kinematics, loss of neuromuscular feedback, increased medial compartment contact, and shear forces. 1,2 In an effort to decelerate this degenerative process, arthroscopic anterior cruciate ligament reconstruction (ACLR) using tendon autografts has been one of the most popular surgical interventions worldwide. 3 However, despite the numerous surgical techniques described, ACLR improves the patient's activity level and reduces, but does not eliminate, the risk of joint degeneration and the necessity for further surgery. 2,3 Restoration of normal ACL anatomy requires anatomic remodeling, fiber maturation, and ligamentization of the applied graft. Early ACL remnantesparing techniques support the theory of preserving the proprioceptive receptors, enhancing the revascularization process, and finally, achieving "cellular ligamentization." 4 However, ACL remnanteretaining procedures can be technically demanding and predispose to cyclops lesion formation. 5 The purpose of this study is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur using a "lasso loop" reeved through the femoral EndoButton (EndoButton CL; Smith & Nephew Endoscopy, Andover, MA). 6 Surgical Technique Joint Assessment and Graft PreparationThe patient is positioned supine with a thigh tourniquet and a standard leg holder allowing full knee range of motion. With a 4.0-mm 30 arthroscope, standard anterolateral and anteromedial (AM) portals are made. The knee joint is evaluated, and other associated lesions are assessed and addressed appropriately. The ACL tear i...

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The Anterior Cruciate Ligament Remnant: To Leave It or Not?

Cited by 51 publications

References 36 publications

The Use of Autologous Fibroblasts for the Reconstruction of the Anterior Cruciate Ligament Tears

The Use of Autologous Fibroblasts for the Reconstruction of the Anterior Cruciate Ligament Tears

Anterior Cruciate Ligament Reconstruction With Preservation of Femoral Anterior Cruciate Ligament Stump

Anterior Cruciate Ligament Remnant–Preserving Reconstruction Using a “Lasso-Loop” Knot Configuration

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