Effects of Remnant Tissue Preservation on Clinical and Arthroscopic Results After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: Comparison among different age Groups
Author(s):
Ebata T. (Japan)
,
Ebata T. (Japan)
Affiliations:
Kondo E.
,
Kondo E.
Affiliations:
Iwasaki K.
,
Iwasaki K.
Affiliations:
Chimbe M.
,
Chimbe M.
Affiliations:
Onodera Jun
,
Onodera Jun
Affiliations:
Yasuda K.
,
Yasuda K.
Affiliations:
Yagi T.
,
Yagi T.
Affiliations:
Iwasaki N.
Iwasaki N.
Affiliations:
ESSKA Academy. Ebata T. 05/09/18; 209406; P05-390 Topic: Arthroscopic Surgery
Taku Ebata
Taku Ebata
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Abstract
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Objectives: Remnant preservation has been expected to have several potential advantages such as enhanced graft coverage, accelerated cell repopulation and revascularization. We reported that anatomic double-bundle (DB) ACL reconstruction (ACLR) with remnant tissue preservation significantly improved postoperative knee stability. However, no studies that clarified the age-based differences in clinical outcome after DB ACLR with remnant preservation have been reported to date. The purpose of this study was to compare clinical outcomes of DB ACLR with and without remnant preservation among different age groups.

Methods: A total of 250 patients (149 men and 101 women) who underwent unilateral anatomic DB ACLR were unrolled in this study between 2009 and 2016. The mean age was 29 (13-71) years. Based on the Crain classification of ACL remnant tissue, 121 patients of Crain Type I, II, and III underwent remnant-preserving (RP) procedure, and the remaining 129 patients of Type IV underwent remnant-resecting (RR) procedure. These patients were divided into three groups: (1) patients younger than 25 years (Group Y), (2) patients aged between 25 and 39 years (Group M), and (3) patients older than 40 years (Group O). All patients were evaluated at 2 year after surgery. 171 patients underwent 2nd-look arthroscopic examination (82 and 89 patients in RP and RR procedures). We evaluated graft quality, based on previous reported scoring system including graft laceration and synovial coverage. Statistical analyses were made using Mann-Whitney U test and Chi-square test. The significance level was set at p=0.05.

Results: (1) Overall evaluation: The side to side differences in the anterior laxity was significantly less (p=0.04) in RP procedure (1.4 mm) than in RR procedure (0.9 mm). In 2nd look observation, the overall evaluation score was significantly (p=0.04) better in RP procedure than in RR procedure. (2) Age differences: In each age group, there were no significant differences in Lysholm score and IKDC evaluation between the 2 procedures. Concerning 2nd-look arthroscopic evaluation, Group O was significantly worse (p=0.04) than that of Groups Y and M in RR procedure. On the other hand, there was no significant difference in arthroscopic evaluation among 3 different age groups in RP procedure. Group O of RP procedure was significantly better (p=0.01) than that of RR procedure. In other age groups, there was no significant difference in arthroscopic evaluation between RP and RR procedures.

Conclusions: In anatomic DB ACLR with remnant tissue preservation, there were no significant differences in clinical outcome between the different age groups. However, in patients older than 40 years, 2nd look evaluation of ACL grafts in patients with remnant-preserving procedure was significantly better than that with remnant-resecting procedure. These data indicated that remnant preservation in DB ACLR might enhance the remodeling of ACL graft in middle-aged patients.

Keywords:
Anterior cruciate ligament, remnant tissue preservation, middle-aged,
Objectives: Remnant preservation has been expected to have several potential advantages such as enhanced graft coverage, accelerated cell repopulation and revascularization. We reported that anatomic double-bundle (DB) ACL reconstruction (ACLR) with remnant tissue preservation significantly improved postoperative knee stability. However, no studies that clarified the age-based differences in clinical outcome after DB ACLR with remnant preservation have been reported to date. The purpose of this study was to compare clinical outcomes of DB ACLR with and without remnant preservation among different age groups.

Methods: A total of 250 patients (149 men and 101 women) who underwent unilateral anatomic DB ACLR were unrolled in this study between 2009 and 2016. The mean age was 29 (13-71) years. Based on the Crain classification of ACL remnant tissue, 121 patients of Crain Type I, II, and III underwent remnant-preserving (RP) procedure, and the remaining 129 patients of Type IV underwent remnant-resecting (RR) procedure. These patients were divided into three groups: (1) patients younger than 25 years (Group Y), (2) patients aged between 25 and 39 years (Group M), and (3) patients older than 40 years (Group O). All patients were evaluated at 2 year after surgery. 171 patients underwent 2nd-look arthroscopic examination (82 and 89 patients in RP and RR procedures). We evaluated graft quality, based on previous reported scoring system including graft laceration and synovial coverage. Statistical analyses were made using Mann-Whitney U test and Chi-square test. The significance level was set at p=0.05.

Results: (1) Overall evaluation: The side to side differences in the anterior laxity was significantly less (p=0.04) in RP procedure (1.4 mm) than in RR procedure (0.9 mm). In 2nd look observation, the overall evaluation score was significantly (p=0.04) better in RP procedure than in RR procedure. (2) Age differences: In each age group, there were no significant differences in Lysholm score and IKDC evaluation between the 2 procedures. Concerning 2nd-look arthroscopic evaluation, Group O was significantly worse (p=0.04) than that of Groups Y and M in RR procedure. On the other hand, there was no significant difference in arthroscopic evaluation among 3 different age groups in RP procedure. Group O of RP procedure was significantly better (p=0.01) than that of RR procedure. In other age groups, there was no significant difference in arthroscopic evaluation between RP and RR procedures.

Conclusions: In anatomic DB ACLR with remnant tissue preservation, there were no significant differences in clinical outcome between the different age groups. However, in patients older than 40 years, 2nd look evaluation of ACL grafts in patients with remnant-preserving procedure was significantly better than that with remnant-resecting procedure. These data indicated that remnant preservation in DB ACLR might enhance the remodeling of ACL graft in middle-aged patients.

Keywords:
Anterior cruciate ligament, remnant tissue preservation, middle-aged,
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