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Does remnant preservation technique make a difference in arthroscopic single bundle anterior cruciate ligament reconstruction?
ESSKA Academy. Neogi D. May 12, 2018; 218164; FP49-1159
Devdatta Neogi
Devdatta Neogi
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Abstract
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Objectives: Clinical utility of remnant tissue preservation after single-bundle anterior cruciate ligament (ACL) reconstruction has not been established. The aim of this study was to compare the clinical performance and complications between an ACL reconstruction with a remnant-preserving (RP) single-bundle technique and a standard single-bundle technique with no remnant (NR).

Methods: From Jan 2014 to Dec 2015, 106 consecutive patients with single ligament injuries and who underwent single bundle anatomic ACL reconstruction using hamstring graft and followed up for at least 18 months were retrospectively reviewed. Of these 55 knees underwent ACL reconstruction with NR and 51 had RP. Associated meniscal tears were treated appropriately. Patients were reviewed at 6 and 18 months and included range of motion, Lachman test, pivot-shift test, KT-1000 arthrometer side-to-side anterior tibial translation measurements and IKDC clinical scores as well as re-operations and complications. Radiographs in two planes were reviewed for tunnel position in RP group. Statistical analysis was done using SPSS Version 21.0 (SPSS Inc, Chicago, USA).

Results: Time from injury to surgery was significantly shorter (3.6 + 8.6 vs 8.2+16.3 months; P < .05) in RP than in NR group. There was no difference in side-to-side anterior tibial translation between the NR and RP groups. Assessing anterior stability, no difference was found between the groups for the KT arthrometer, negative rate of Lachman, and the pivot shift test. Assessing functional outcome, there was no significant difference in IKCD scores. In NP group there were 9 medial meniscus (MM), 16 lateral meniscus (LM) and 10 involving both menisci tears while in RP group there were 9 MM, 15 LM and 6 both menisci. ACL graft rupture occurred in 2 (3.9%) patients in RP and in 5 (9%) patients in NR (P < .05). In patients with intact ACLs at follow-up 4 pts in RP and 3 pts in NR required additional surgery. Of this 2 in RP group was for inability to achieve full extension while rest were for meniscal pathology either failure of repairs (4) or re-tears (1). There was one case of late infection at the tibial incision site in RP. Radiographs showed good position of tibial tunnel in all cases in RP group.

Conclusions: Remnant preservation in anatomic single-bundle ACL reconstruction did not significantly improve subjective and functional results in the short-term evaluation, but it showed less re-rupture rates. There were no concerns regarding tibial tunnel placement in RP technique.

Keywords:
anterior cruciate ligament; knee ligaments; single-bundle reconstruction; remnant tissue
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