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
