The Influence of Anterior Cruciate Ligament Remnant on Postoperative Clinical Results in Patients with Remnant Preserving Anterior Cruciate Ligament Reconstruction
Abstract:BACKGROUND:Anterior Cruciate Ligament (ACL) remnants have important biomechanical, vascular and proprioceptive function.AIM:To determine the influence of the ACL residual remnants after partial and complete ACL ruptures on postoperative clinical results in patients with remnant preserving ACL reconstruction.PATIENTS AND METHODS:The study included 66 patients divided into two groups. In patients from the investigation group remnant preserving ACL reconstruction was performed, in patients from the control group … Show more
“…A total of 284 citations were discarded because they were duplicates or did not fit the eligibility criteria. After full-text verification of the remaining 15 articles, seven studies with a combined 412 patients (208 in the remnant preservation technique group and 204 in the standard technique group) were included in the meta-analysis [ 17 – 23 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Sensitivity analysis was conducted to explore the possibility of heterogeneity in stability outcomes. The results showed that there was no particularly influential study among the included studies, except for the effects of the studies of Andonovski on side-to-side difference [ 23 ]. The mean follow-up time in this trial was 7 months.…”
BackgroundThis meta-analysis was performed to compare the clinical outcomes of primary anterior cruciate ligament (ACL) reconstruction using the ACL remnant preservation technique versus the standard technique.MethodsPubMed, Embase, and the Cochrane Library were searched through December 24, 2017, to identify randomized controlled studies that compared the use of the ACL remnant preservation technique versus the standard technique for primary ACL reconstruction. Statistical heterogeneity among the trials was evaluated with chi-square and I-square tests. A sensitivity analysis was conducted to explore sources of heterogeneity. Subgroup analysis was performed to identify potential differences according to type of ACL remnant tissue (remnant bundle or remnant fibers).ResultsSeven studies with a combined 412 patients (208 in the remnant preservation technique group and 204 in the standard technique group) were included in the meta-analysis. There was a significant difference between the groups in Lysholm score (mean difference (MD), 2.20; 95% confidence interval (CI), 0.95–3.45; P = 0.0006) and side-to-side difference (MD, − 0.71; 95% CI, − 0.87 to − 0.55; P < 0.01). There was no significant difference between the groups in subjective International Knee Documentation Committee (IKDC) score, complications, pivot shift test, Lachman test, or overall IKDC score. Subgroup analysis demonstrated that for primary ACL reconstruction with preservation of remnant fibers, the remnant preservation technique was superior to the standard technique based on Lysholm scores (P < 0.01) and side-to-side difference (P < 0.01).ConclusionsBased on the current literature, using the remnant preservation technique showed a better clinical outcome than using the standard technique for patients undergoing primary ACL reconstruction with respect to Lysholm score and side-to-side difference. However, it remains unclear that there is a definite advantage to use the remnant preservation technique compared with the standard technique.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0937-4) contains supplementary material, which is available to authorized users.
“…A total of 284 citations were discarded because they were duplicates or did not fit the eligibility criteria. After full-text verification of the remaining 15 articles, seven studies with a combined 412 patients (208 in the remnant preservation technique group and 204 in the standard technique group) were included in the meta-analysis [ 17 – 23 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Sensitivity analysis was conducted to explore the possibility of heterogeneity in stability outcomes. The results showed that there was no particularly influential study among the included studies, except for the effects of the studies of Andonovski on side-to-side difference [ 23 ]. The mean follow-up time in this trial was 7 months.…”
BackgroundThis meta-analysis was performed to compare the clinical outcomes of primary anterior cruciate ligament (ACL) reconstruction using the ACL remnant preservation technique versus the standard technique.MethodsPubMed, Embase, and the Cochrane Library were searched through December 24, 2017, to identify randomized controlled studies that compared the use of the ACL remnant preservation technique versus the standard technique for primary ACL reconstruction. Statistical heterogeneity among the trials was evaluated with chi-square and I-square tests. A sensitivity analysis was conducted to explore sources of heterogeneity. Subgroup analysis was performed to identify potential differences according to type of ACL remnant tissue (remnant bundle or remnant fibers).ResultsSeven studies with a combined 412 patients (208 in the remnant preservation technique group and 204 in the standard technique group) were included in the meta-analysis. There was a significant difference between the groups in Lysholm score (mean difference (MD), 2.20; 95% confidence interval (CI), 0.95–3.45; P = 0.0006) and side-to-side difference (MD, − 0.71; 95% CI, − 0.87 to − 0.55; P < 0.01). There was no significant difference between the groups in subjective International Knee Documentation Committee (IKDC) score, complications, pivot shift test, Lachman test, or overall IKDC score. Subgroup analysis demonstrated that for primary ACL reconstruction with preservation of remnant fibers, the remnant preservation technique was superior to the standard technique based on Lysholm scores (P < 0.01) and side-to-side difference (P < 0.01).ConclusionsBased on the current literature, using the remnant preservation technique showed a better clinical outcome than using the standard technique for patients undergoing primary ACL reconstruction with respect to Lysholm score and side-to-side difference. However, it remains unclear that there is a definite advantage to use the remnant preservation technique compared with the standard technique.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0937-4) contains supplementary material, which is available to authorized users.
“…In particular, negating the requirement for autografts would theoretically solve troublesome donor site morbidity issues such as loss of hamstrings strength and anterior knee pain. Current practices and trends towards remnant preservation and some of the improvements shown in subjective proprioceptive outcomes, knee stability and revision rate (Takazawa et al 2013 ; Takahashi et al 2016 ; Muneta and Koga 2017 ; Andonovski et al 2017 ) can be extrapolated to offer hypothetical benefits for primary repair over reconstruction.…”
BackgroundThis article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques. PubMed (MEDLINE), EMBASE and Cochrane Library databases for papers relating to primary anterior cruciate ligament reconstruction were searched by all participating authors. All relevant historical papers were included for analysis. Additional searches of the same databases were made for papers relating to biological enhancement of ligament healing.Current standardThe poor capacity of the ACL to heal is one of the main reasons why the current gold standard surgical treatment for an ACL injury in an athletic patient is ACL reconstruction with autograft from either the hamstrings or patella tendon. It is hypothesised that by preserving and repairing native tissues and negating the need for autograft that primary ACL repair may represent a key step change in the treatment of ACL injuries.History of primary ACL repairThe history of primary ACL repair will be discussed and the circumstances that led to the near-abandonment of primary ACL repair techniques will be reviewed.New primary repair techniquesThere has been a recent resurgence in interest with regards to primary ACL repair. Improvements in imaging now allow for identification of tear location, with femoral-sided injuries, being more suitable for repair. We will discuss in details strategies for improving the mechanical and biological environment in order to allow primary healing to occur.In particular, we will explain mechanical supplementation such as Internal Brace Ligament Augmentation and Dynamic Intraligamentary Stabilisation techniques. These are novel techniques that aim to protect the primary repair by providing a stabilising construct that connects the femur and the tibia, thus bridging the repair.Bio enhanced repairIn addition, biological supplementation is being investigated as an adjunct and we will review the current literature with regards to bio-enhancement in the form platelet rich plasma, bio-scaffolds and stem cells. On the basis of current evidence, there appears to be a role for bio-enhancement, however, this is not yet translated into clinical practice.ConclusionsSeveral promising avenues of further research now exist in the form of mechanical and biological augmentation techniques. Further work is clearly needed but there is renewed interest and focus for primary ACL repair that may yet prove the new frontier in ligament repair.
“…Over the last few years, with the recognition of the importance of tear type and tissue quality, there has been a renewed interest in arthroscopic primary ACL repair [ 20 , 24 , 41 , 43 ]. So, we noticed a crucial shift in favor of the preservation of the native ACL, even as a remnant in the cases of ACL reconstruction [ 49 ]. Kondo et al showed that remnant preservation in anatomic double-bundle ACL reconstruction significantly improved postoperative knee stability [ 50 ].…”
Section: Main Textmentioning
confidence: 99%
“…Kondo et al showed that remnant preservation in anatomic double-bundle ACL reconstruction significantly improved postoperative knee stability [ 50 ]. The importance of proprioception in knee stability and self-protection from a re-rupture led the orthopedic science to investigate new primary ACL repair techniques [ 49 , 50 ]. In a way, our findings suggest that orthopedic science has moved “back to the future” by rediscovering previous anterior cruciate ligament repair strategies couched in sophisticated, modernized surgical techniques of the twentieth-first century.…”
Recently, four different operative techniques, referring to the primary anterior cruciate ligament (ACL) repair, were described. These are the dynamic intraligamentary stabilization (DIS) with Ligamys™, the Bridge-enhanced repair (BEAR), the use of internal brace, and the refixation with suture anchors. The purpose of this study was to assess the already-published, clinical, and pre-clinical results of those techniques. A literature review was conducted and implemented by three independent researchers. Inclusion criteria were clinical or cadaveric or animal studies about patients suffering from ACL rupture, who were treated with one of those four different arthroscopic techniques of primary ACL repair. There were 10 clinical trials dealing with the different techniques of primary ACL repair and 12 cadaveric or animal studies. The majority of the published clinical trials investigated the dynamic intraligamentary stabilization (DIS), while only four studies referred to the three other surgical techniques. Most of the clinical trials suggested that primary ACL repair should be done during the first 14–21 days after a proximal ACL rupture and not later. Further clinical evidence is needed for the techniques of bridge-enhanced ACL repair, internal brace, and suture anchors ACL refixation in order to support the animal and cadaveric biomechanical studies. Till now, the existing clinical trials were not enough to establish the use of those techniques in the ACL-ruptured patients. On the contrary, the Dynamic intraligamentary stabilization with Ligamys™ device demonstrated very promising results in different types of clinical studies.
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