The effects of remnant-preserving anterior cruciate ligament reconstruction on proprioception: A prospective comparative study

Abstract

Objective: The aim of this study was to investigate the effects of anterior cruciate ligament reconstruction performed by preserving remnant tissue on proprioception and to assess the effects it has on isokinetic quadriceps and hamstring muscle strength, as well as on range of motion and functional scores. Methods: A prospective study was conducted with 44 patients who underwent either anterior cruciate ligament reconstruction with remnant preservation (study group, n = 22) or with remnant excision (control group, n = 22) with the use of a 4-strand hamstring allograft. The mean follow-up time was 20.2 ± 1.4 months after surgery. Using an isokinetic dynamometer, proprioception was evaluated with passive joint position perception at 150, 450, and 600, and quadriceps femoris, and hamstring muscle strength were evaluated at speeds of 900, 1800, and 2400 per second. Range of motion was measured using a goniometer. Functional outcomes were assessed using International Knee Documentation Committee subjective knee evaluation score and Lysholm knee scoring questionnaires. Results: It was only at 15° of knee flexion that there was a statistically significant difference in proprioception; the median of the difference in the amount of deviation from the target angle between the healthy knee and the operated side was 1.7 (range, 0.7-20.7) in those with remnant preserved, and 2.7 (range, 1-26) in those with remnant excised ( P = .016). At 2400/s speed, the mean quadriceps femoris strength was 77.2 ± 24.3 Nm in those with remnant preserved and 67.6 ± 24.2 Nm in those with remnant excised. ( P = .048) There was no difference between the 2 groups in terms of range of motion, International Knee Documentation Committee, and Lysholm knee scoring. ( P > .05) Conclusion: The present study has demonstrated that better proprioception and higher quadriceps femoris muscle strength can be obtained by remnant-preserving anatomical single-bundle anterior cruciate ligament reconstruction using a hamstring autograft.

Evaluating the Efficacy of Reconstruction: Systematic Review of Six-Strand Hamstring Autografts for Anterior Cruciate Ligament Reconstruction: Biomechanical and Clinical Outcomes

“…Moreover, long-term follow-up studies are essential to fully understand the durability of these grafts and their impact on knee joint health over time. Investigating the biomechanical properties of 6HS autografts in various patient populations, including those with different activity levels and biomechanical demands, would further refine the selection criteria for this graft option in ACL reconstruction surgery [21][22][23][24][25][26][27][28][29][50][51][52] (Figure 4). ly for individuals with high physical demands or those at increased risk of graft failure.…”

Clinical Outcomes in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Controlled Accelerated Rehabilitation

“…In this surgical technique, the hamstring tendon is the most commonly preferred graft, followed by the patellar tendon and quadriceps tendon as other frequently chosen graft types. The most commonly used materials for femoral fixation are Endobuttons, cross-pins, and bioabsorbable screws, while for tibial fixation, bioabsorbable or titanium screws and staples are typically utilized [ 8 , 9 ].…”

“…While rehabilitating after ACL reconstruction, it is crucial to consider the graft type, how it is secured in the bone tunnels, as well as the patients’ ages (chronological and physiological), activity levels, athletic history, and expectations for future participation [ 10 ]. Both standard and accelerated rehabilitation have been described in the literature and their advantages and disadvantages have been reported [ 9 - 15 ]. Standard rehabilitation may result in a delayed range of motion and may make patients more susceptible to possible complications such as arthrofibrosis.…”