2017 ISAKOS Biennial Congress ePoster #1118

 

Comparison of the Clinical Results between Anatomic Double Bundle ACL Reconstruction with and without Remnant Tissue Preservation

Tsuneari Takahashi, MD, PhD, Maebashi, Gunma JAPAN
Takashi Ohsawa, MD, PhD,, Maebashi, Gunma JAPAN
Keiichi Hagiwara, MD, PhD, Mebashi-City, Gunma JAPAN
Shinya Yanagisawa, MD, Maebashi JAPAN
Atsuko Ogoshi, MD, Maebashi-City, GUNMA JAPAN
Tomoyuki Nakagawa, MD, Maebashi-Shi, Gunma-ken JAPAN
Hiroyuki Shiozawa, MD, PhD,, Maebashi, Gunma JAPAN
Kosuke Suzuki, MD, Maebashi JAPAN
Chang Gi Zhong, MD, PhD, Maebahi JAPAN
Masashi Kimura, MD, PhD, Gumma JAPAN
Katsushi Takeshita JAPAN

Zenshukai Hospital Gunma Sports Medicine Research Center, Maebashi, Gunma, JAPAN

FDA Status Cleared

Summary

We have compared the clinical results after ACL reconstruction w/ and w/o remnant tissue preservation. SNQ at the grafted tendon were significantly smaller in Remnant group. Patients in Remnant group had significantly better synovial coverage in second look arthroscopic evaluation. There is a possibility that remnant tissue preservation in ACL reconstruction accelerates the graft maturation.

Abstract

Introduction

Clinical results after Anterior Cruciate Ligament (ACL) reconstruction have been improved after developing of anatomic reconstruction. However, there still remain issues to achieve the recovery to the functionally normal knee. Recently, ACL remnant tissue attracts the attention because there is a possibility to accelerate the remodeling phase of the graft.

Purpose

To clarify the effectiveness of remnant tissue preservation in anatomic double bundle ACL reconstruction.

Methods

75 patients with unilateral ACL injury and underwent anatomic double bundle ACL reconstruction using hamstring autograft tendon with or without remnant tissue preservation and second look arthroscopic evaluation averaged 1 year after surgery were enrolled in this study. There were 32 patients underwent anatomic double ACL reconstruction (Non remnant group) and 43 patients underwent same procedure with remnant tissue preservation (Remnant Group). We retrospectively compared Lysholm score, IKDC subjective scale, Tegner activity scale before and averaged 1year after surgery, pre and post operative side to side difference (SSD) using TelosTM, radiological evaluation of the grafted tendon using signal/noise quotient (SNQ), and arthroscopic evaluation of the grafted tendon. SNQ was calculated using the region of interest (ROI) technique. The intra- articular signal of the grafted tendon was divided into 3 zones to analyze the signal intensity. The tibial, mid, and femoral thirds were defined as three zones, respectively.

Results

There were no significant differences in functional knee score before and after surgery between two groups. Postoperative SSD in Group P (0.78+/–1.90 mm) tended to be smaller than that in Group N (1.29+/–2.18 mm) however, P value was not significant (P=0.30). After dividing the cases in Group P into 2 subgroups, SSD in patients with sufficient remnant coverage (-0.56+/–1.38 mm) was significantly smaller than that in patients with insufficient remnant coverage (1.48+/–1.77 mm) (P=0.019) and also significantly smaller than that in Group N (P=0.019). Concerning the SNQ values, there were significant differences at the proximal and distal ACL grafted tendon between the groups. SNQ value at the proximal portion in Group P (19.1+/–10.7) was significantly smaller than that in Group N (25.4+/–15.5) (P=0.049). SNQ value at the distal portion in Group P (16.0+/–13.4) was significantly smaller than that in Group N (23.1+/–14.8) (P=0.039). SNQ value at the middle portion in Group P was 19.3+/–14.1 and 25.7+/–15.9 in Group N. However, P value was not significant (P=0.084).
Arthroscopic evaluation at the time of second look surgery revealed that the incidence of Cyclops lesion between the groups was not significantly different. The degree of synovial coverage of AMB grafted tendon was significantly better in Group P than that in Group N (P=0.0064) and the degree of synovial coverage of PLB grafted tendon was significantly better in Group P than that in Group N (P=0.032).

Discussion

Preservation of ACL remnant tissue may enhance not only synovial coverage of the grafted tendon but also graft maturation without increasing of Cyclops lesion. Furthermore, sufficient remnant tissue coverage may contribute the better knee stability.