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J Knee Surg 2019; 32(06): 565-576
DOI: 10.1055/s-0038-1660513
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Remnant Tissue Preservation in Anatomic Double-Bundle ACL Reconstruction on Knee Stability and Graft Maturation

Authors

  • Tsuneari Takahashi

    1   Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan
    2   Department of Orthopedic Surgery, Faculty of Medicine, Jichi Medical University, Shimotsuke, Japan

  • Masashi Kimura

    1   Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan

  • Keiichi Hagiwara

    1   Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan

  • Takashi Ohsawa

    3   Department of Orthopedic Surgery, Faculty of Medicine, Gunma University, Maebashi, Japan

  • Katsushi Takeshita

    2   Department of Orthopedic Surgery, Faculty of Medicine, Jichi Medical University, Shimotsuke, Japan
Further Information

Publication History

23 January 2018

05 May 2018

Publication Date:
13 June 2018 (online)

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Abstract

Several investigators have developed anterior cruciate ligament reconstructions (ACLR) with remnant tissue preservation (RTP) and have reported better clinical outcomes. However, the effects of RTP remain controversial. To date, no reports have compared both clinical and radiological outcomes of anatomic double-bundle ACLR using the hamstring tendon and outside-in technique with/without RTP. This article evaluates the effectiveness of RTP in ACLR on knee stability and graft maturation. In total, 75 patients with unilateral ACL injury who had undergone anatomic double-bundle ACLR using autografted hamstring tendon either with RTP (Group P, n = 43) or without (Group N, n = 32) were enrolled. Clinical scores, pre- and postoperative side-to-side differences (SSDs) obtained using Telos, radiological evaluations of the grafted tendon using the signal/noise quotient (SNQ) measured using magnetic resonance imaging, and arthroscopic evaluations of the grafted tendon were retrospectively compared between the groups. Postoperative SSDs were smaller in the Group P (0.78 ± 1.90 mm) than in the Group N (1.29 ± 2.18 mm); however, this difference was not significant. Comparing two subgroups of the Group P, the SSD was significantly smaller in those with sufficient remnant coverage (−0.56 ± 1.38 mm) than in those without (1.48 ± 1.77 mm) (p = 0.019), as well as in the Group N patients (p = 0.019). The degree of synovial coverage of the anteromedial (p = 0.0064) and posterolateral (p = 0.032) bundle grafted tendon at the time of second-look arthroscopy was significantly better in the Group P than in the Group N. SNQ values of ACL grafted tendon at proximal (p = 0.049), middle, and distal (p = 0.039) one-third in Group P were better than those in Group N. RTP may enhance synovial coverage and maturation of the grafted tendon. Sufficient remnant tissue coverage may contribute to better knee stability. This is a Level III, retrospective comparative study.

Keywords

anterior cruciate ligament reconstruction - remnant tissue - Telos - magnetic resonance imaging - arthroscopy

Note

This study was performed at Gunma Sports Medicine Research Center, Zenshukai Hospital, Maebashi, Japan.


Authors' Contributions

T.T. designed the study and acquired, analyzed, and interpreted data. M.K., K.H., T.O., and K.T. participated in study conception and design and revision of the data and manuscript. All authors read and approved the final manuscript.


Ethical Approval

The Institutional Review Board of the ethics committee of our institution approved this retrospective comparative study. Approval number was 170404. This research involved a retrospective comparative study of electronic medical records and videos collected at the time of ACL reconstruction surgery and second look arthroscopy. Therefore, the ethical committee of our institution waived the requirement for formal written informed consent.