2015 ISAKOS Biennial Congress ePoster #1269

Effects of Remnant Ligament Tissue Preservation on the Clinical Outcome After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Eiji Kondo, MD, PhD, Sapporo, Hokkaido JAPAN
Jun Onodera, MD, PhD, Sapporo, Hokkaido JAPAN
Yasuyuki Kawaguchi, MD, PhD, Ikoma, Nara JAPAN
Nobuto Kitamura, MD, PhD, Sapporo, Hokkaido JAPAN
Norimasa Iwasaki, MD, PhD, Sapporo, Hokkaido JAPAN
Kazunori Yasuda, MD, PhD, Prof., Sapporo, Hokkaido JAPAN
Department of Advanced Therapeutic Research for Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, JAPAN

FDA Status Not Applicable

Summary: The present study demonstrated that sufficient intra-operative graft coverage by the remnant tissue in anatomic double-bundle ACL reconstruction significantly improved the knee stability in the 2-year clinical outcome.

Abstract:

Introduction

Recently, we reported a novel procedure for anatomic double bundle ACL reconstruction with remnant tissue preservation [1]. However, no studies have shown any clinical evidence about the utility of the remnant tissue preservation in double-bundle ACL reconstruction as of yet. Therefore, we have conducted a prospective comparative study to clarify the clinical effect of the remnant tissue preservation in anatomic double-bundle ACL reconstruction. We have hypothesized that sufficient intra-operative graft coverage by the remnant tissue in anatomic double-bundle ACL reconstruction may significantly improve the clinical outcome, specifically concerning the knee stability. The purpose of this study was to test this hypothesis.

Methods

A prospective, comparative study was conducted with 170 patients who underwent anatomic double-bundle ACL reconstruction between 2010 and 2012. During surgery, we arthroscopically evaluated the status of the remnant ACL tissue. In 98 of the 170 patients, we could not find sufficient remnant ACL tissue, and we performed anatomic double-bundle ACL reconstruction without remnant preservation [2]. In the remaining 72 patients who had the remnant ACL tissue (Crain’s Type 1, 2, or 3 [3]), we performed the same double-bundle ACL reconstruction with our original remnant tissue preservation technique [1]. We evaluated the degree of coverage of each graft by the remnant tissue at the end of surgery, using an original scoring system. Then, all the patients were divided into 3 groups, based on the degree of coverage of the anteromedial (AM) bundle by the preserved remnant tissue. In Group I (52 patients), AM graft coverage was evaluated as ‘Excellent’. In Group II (20 patients), AM graft coverage was evaluated as ‘Poor’. In Group III (98 patients), AM graft was not covered by the remnant tissue. There were no significant differences in the background factors among the 3 groups. All patients were followed up at 2 years after surgery, and we evaluated the standard clinical evaluation methods including the side-to-side anterior laxity measured with KT-2000.

Results

The post-operative anterior laxity was 0.7 +/- 2.2 mm, 1.2 +/- 2.0 mm, and 1.5 +/- 1.5 mm in Groups I, II, and III, respectively. The laxity of Group I was significantly less than that of Group III (p=0.0135). Concerning the Lysholm knee score, the IKDC evaluation, and the peak muscle torque of quadriceps and hamstrings, there were no significant differences among the 3 groups. In second-look arthroscopy, there were no significant differences in the occurrence rate of the cyclops lesion among the 3 groups.

Discussion

and Conclusions: The present study demonstrated that sufficient intra-operative graft coverage by the remnant tissue in anatomic double-bundle ACL reconstruction significantly improved the knee stability in the 2-year clinical outcome. On the other hand, there was no obvious difference in the knee stability between the Groups II and III. This fact suggested that, in remnant tissue preserving ACL reconstruction, the quality and the quantity of the graft coverage by the preserved remnant tissue are essential factors which significantly affect the clinical outcome. This study also showed that the remnant tissue preservation did not have any adverse effects on the other clinical measures, such as the postoperative range of motion. These facts have provided us with important information to conduct a prospective randomized study in the near future in order to evaluate the clinical utility of the anatomic double-bundle ACL reconstruction with remnant tissue preservation.

References:
[1] Yasuda et al. Arthroscopy 2012 [2] Yasuda et al. Arthroscopy 2004 [3] Crain et al. Arthroscopy 2005