Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft with Remnant Preservation: Comparison of Outcomes According to the Amount of Remnant Tissue

AbstractThere has been controversy about whether remnant tissue of anterior cruciate ligament (ACL) has to be preserved in ACL reconstruction. The purpose of the study was to compare clinical outcomes between groups of patients who underwent ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft divided according to amount of ACL remnant and investigate effect of remnant preservation on outcomes of ACL reconstruction. A total of 185 patients who underwent ACL reconstruction with BPTB autograft were retrospectively reviewed. Patients were divided into four groups according to proportion of length of remnant tissue of injured ACL covering part of reconstructed ACL to total length of reconstructed ACL: group A included 83 patients with no remnant, group B consisted of 38 patients with remnant of < 1/3, group C consisted of 35 patients with remnant of 1/3 to2/3, and group D consisted of 29 patients with remnant of > 2/3. Primary outcome was International Knee Documentation Committee (IKDC) subjective score. Secondary outcomes were stability, range of motion, patient-reported outcomes determined by Lysholm knee scoring scale and Tegner activity scale, IKDC objective grade, and single hop for distance. Return to activity and near-return to activity were investigated. A minimum follow-up duration was 24 months. There was no statistically significant difference between four groups regarding postoperative anterior translation (p = 0.731), Lysholm knee score (p = 0.599), IKDC objective grade (p > 0.999), hop test (p = 0.878), and near-return to activity (p = 0.193). However, patients of group D had significantly better outcomes in IKDC subjective score (group A = 85.0 ± 5.9, group B = 84.9 ± 8.1, group C = 87.4 ± 6.4, group D = 89.2 ± 8.1, p = 0.017), Tegner activity scale (group A = 5.0 ± 1.1, group B = 5.2 ± 1.0, group C = 5.7 ± 1.3, group D = 5.9 ± 1.0, p = 0.001), and return to activity (group A = 25.3%, group B = 31.6%, group C = 45.7%, group D = 55.2%, p = 0.014). ACL reconstruction using BPTB autograft with remnant preservation did not provide better anterior stability compared with conventional ACL reconstruction. However, preservation of remnant of > 2/3 led to more improved activity-related clinical outcomes than no remnant preservation. In cases with substantial remnant tissue of injured ACL remaining, reconstruction of ACL while preserving as much remnant tissue as possible is recommended. This is a Level III, retrospective comparative therapeutic study.

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Is Intraoperative Fluoroscopy Necessary to Confirm Device Position for Femoral-Sided Cortical Suspensory Fixation during Anterior Cruciate Ligament Reconstruction?

The Journal of Knee Surgery ◽

10.1055/s-0039-1678523 ◽

2019 ◽

Vol 33 (03) ◽

pp. 265-269

Author(s):

B. Christian Balldin ◽

Clayton W. Nuelle ◽

Thomas M. DeBerardino

Keyword(s):

Acl Reconstruction ◽

Intraoperative Imaging ◽

Cruciate Ligament ◽

Intraoperative Fluoroscopy ◽

Suspensory Fixation ◽

Fluoroscopic Imaging ◽

Group A ◽

Anterior Cruciate ◽

Group B ◽

Device Location

AbstractIncreased laxity within the graft construct system can lead to graft failure after anterior cruciate ligament (ACL) reconstruction. Suboptimal cortical device positioning could lead to increased laxity within the system, which could influence the mechanics and function of the graft reconstruction. This study evaluates the benefit of intraoperative fluoroscopy to confirm device position on the femur during ACL reconstruction using cortical suspensory fixation. One hundred consecutive patients who underwent soft tissue ACL reconstruction using a suspensory cortical device for femoral fixation were retrospectively evaluated. Patients were split into two groups: Group A utilized anteromedial portal visualization and had intraoperative fluoroscopic imaging performed at the time of ACL graft fixation to confirm femoral device placement on the lateral femoral metaphyseal cortex. Group B utilized anteromedial portal visualization alone. Both groups had radiographic X-rays performed at the first postoperative visit to evaluate device location and all images were independently evaluated by three fellowship trained orthopaedic surgeons. Device position was classified as optimal if there was complete apposition of the entire device against the femoral cortex and suboptimal if it was > 2 mm off the cortex. Fisher's exact test, analysis of variance, and 95% confidence intervals were calculated to compare the groups for statistical significance. The results showed 0/60 (0%) patients in group A had suboptimal device position at postoperative follow-up, while 4/40 (10%) patients in group B had suboptimal device position (p = 0.013). There were no graft failures in group A and one graft failure in group B. There was a significant difference in cortical device position in patients who had intraoperative fluoroscopic imaging versus patients who had no intraoperative imaging. The use of confirmatory intraoperative imaging may be beneficial to confirm appropriate device location when using a femoral cortical suspensory fixation technique for ACL reconstruction.

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Safety of the application of Rigidfix cross-pin system via different tibial tunnels for tibial fixation during anterior cruciate ligament reconstruction

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03645-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Jian Wang ◽

Hua-qiang Fan ◽

Wenli Dai ◽

Hong-Da Li ◽

Yang-pan Fu ◽

...

Keyword(s):

Acl Reconstruction ◽

Patellar Tendon ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Tibial Fixation ◽

Group A ◽

Coronal Section ◽

Anterior Cruciate ◽

Group B ◽

External Aperture

Abstract Background We investigate the safety of the application of the Rigidfix cross-pin system via different tibial tunnels in the tibial fixation during anterior cruciate ligament (ACL) reconstruction. Methods Five adult fresh cadaver knees were fixed with the Rigidfix cross-pins in the tibial fixation site during ACL reconstruction. Two different tibial tunnel groups were established: in group A, the tunnel external aperture was placed at the 25° angle of coronal section; in group B, the tunnel external aperture was placed at the 45° angle of coronal section. The guide was placed at the plane 0.5 mm below articular facet through the tibial tunnel, with three rotation positions set at 0°, 30°, and 60° slopes. The incidences of iatrogenic injuries at tibial plateau cartilage (TPC), medial collateral ligament (MCL), and patellar tendon in three different slope angles were calculated in groups A and B and the results were analyzed by using chi square test. Results The iatrogenic injuries at MCL, TPC, and patellar tendon could occur after the Rigidfix cross-pin system was placed 5 mm below tibial plateau cartilage for ACL reconstruction. The incidences of TPC injury (χ2 = 5.662, P = 0.017) and MCL injury (P = 0.048, Fisher exact probability method) were significantly lower in group A than in group B. However, the incidence of patellar tendon injury showed no significant difference between these two groups (χ2 = 0.120, P = 0.729). Conclusions When the Rigidfix cross-pin system is used for ACL reconstruction at the tibial fixation site, the external aperture of tibial tunnel should not be placed at the excessively posterosuperior site, to avoid MCL and TPC injuries.

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Modified Iliotibial Band Tenodesis Is Indicated to Correct Intraoperative Residual Pivot Shift After Anterior Cruciate Ligament Reconstruction Using an Autologous Hamstring Tendon Graft: A Prospective Randomized Controlled Trial

The American Journal of Sports Medicine ◽

10.1177/0363546520910148 ◽

2020 ◽

Vol 48 (5) ◽

pp. 1069-1077 ◽

Cited By ~ 2

Author(s):

Mark Porter ◽

Bruce Shadbolt

Keyword(s):

Acl Reconstruction ◽

Pivot Shift ◽

Controlled Trial ◽

Cruciate Ligament ◽

Similar Rate ◽

Iliotibial Band ◽

Group A ◽

Ikdc Score ◽

Anterior Cruciate ◽

Group B

Background: The indications for the addition of anterolateral soft tissue augmentation to anterior cruciate ligament (ACL) reconstruction and its effectiveness remain uncertain. Purpose: To determine if modified iliotibial band tenodesis (MITBT) can improve clinical outcomes and reduce the recurrence of ACL ruptures when added to ACL reconstruction in patients with a residual pivot shift. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients with a primary ACL rupture satisfying the following inclusion criteria were enrolled: first ACL rupture, involved in pivoting sports, skeletally mature, no meniscal repair performed, and residual pivot shift relative to the contralateral uninjured knee immediately after ACL reconstruction. Patients were randomized to group A (no further surgery) or group B (MITBT added) and were followed up for 2 years. The patient-reported outcome (PRO) measures used were the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) subscale of sport/recreation (Sport/Rec), KOOS subscale of quality of life (QoL), Lysholm knee score (LKS), Tegner activity scale (TAS), recurrent ACL ruptures, or need for further surgery in either knee. Analysis of variance was used to compare PROs; the Wilcoxon test was used for the TAS; and the chi-square test was used for recurrence of ACL ruptures, meniscal injuries, and contralateral ACL ruptures ( P < .05). Results: A total of 55 patients were randomized: 27 to group A (female:male ratio = 15:12; mean age, 22.3 ± 3.7 years) and 28 to group B (female:male ratio = 17:11; mean age, 21.8 ± 4.1 years). At 2-year follow-up, group A had a similar IKDC score (90.9 ± 10.7 vs 94.2 ± 11.2; respectively; P = .21), lower KOOS Sport/Rec score (91.5 ± 6.4 vs 95.3 ± 4.4, respectively; P = .02), similar KOOS QoL score (92.0 ± 4.8 vs 95.1 ± 4.3, respectively; P = .14), lower LKS score (92.5 ± 4.8 vs 96.8 ± 8.0, respectively; P = .004), lower TAS score (median, 7 [range, 7-9] vs 8 [range, 8-10], respectively; P = .03), higher rate of recurrence (14.8% vs 0.0%, respectively; P < .001), similar rate of meniscal tears (14.8% vs 3.6%, respectively; P = .14), and similar rate of contralateral ACL ruptures (3.7% vs 3.6%, respectively; P = .99) relative to group B. Conclusion: The augmentation of ACL reconstruction with MITBT reduced the risk of recurrent ACL ruptures in knees with a residual pivot shift after ACL reconstruction and improved KOOS Sport/Rec, LKS, and TAS scores. Registration: ACTRN12618001043224 (Australian New Zealand Clinical Trials Registry)

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High Tibial Valgus Osteotomy and Concomitant Anterior Cruciate Ligament Reconstruction. Which is the most appropriate surgical technique?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00236 ◽

2014 ◽

Vol 2 (12_suppl4) ◽

pp. 2325967114S0023

Author(s):

Matías Costa Paz ◽

Juan José Deré ◽

Carlos Heraldo Yacuzzi

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Tibial Slope ◽

Lysholm Score ◽

Peroneal Nerve Injury ◽

Group A ◽

High Tibial Valgus Osteotomy ◽

Anterior Cruciate ◽

Group B ◽

Tibial Valgus

Introduction: The aim of this study is to evaluate advantages of close vs. open HTO of a group of patients who underwent a one-stage combined operation for chronic ACL rupture and early medial compartment arthritis. Material and Methods: We retrospective evaluated two series of patients operated on for anterior cruciate ligament (ACL) reconstruction combined with high tibial valgus osteotomy (HTO) for chronic anterior knee instability associated with medial tibio femoral osteoarthritis. Close HTO using rigid plate fixation and ACL reconstruction with bone patellar tendon bone graft was performed in Group A (7 patients). An open HTO using Puddu plate and ACL reconstruction with hamstring tendon graft was performed in Group B (9 patients). The mean age in Group A was 41 years old with an average varus of 8 degrees. Mean age in Group B was 42 years old and with 4 degrees of varus. Lysholm Score, HSS and Radiographs were performed. Results: Group A obtained a mean Lysholm score of 94, mean HSS of 91. Group B showed a mean Lysholm score of 83, mean HSS of 87. The mean follow-up was 5 years in both groups. In all cases osteotomies consolidated. Discussion: Technically we found that open HTO with hamstrings had several advantages such as lower risk of peroneal nerve injury, use of one incision, no problems as regards graft length, possibility of fixing the graft in the proximal tibia, maintenance of tibial slope and preservation of bone stock. The Open HTO need of osseous graft, may produce patella baja and the risk of nonunion is higher. This technique is indicated for relaxed medial collateral ligament. As regards the Close HTO there may be possibilities of a peroneal nerve injury, it may decrease the tibial slope, patellar ascent, loss of bone, the need to disrupt either the fibula or proximal tibio-fibular joint and may generate instability in the posterolateral corner and the screws could compromise the tunnels path. The advantages are provision of bone to bone contact with excellent union rates and the potential for full early weight-bearing. Conclusion: In spite of these issues, both procedures relieved pain and restored knee stability and the choice will depend on each particular case.

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A steep coronal graft bending angle is associated with bone tunnel enlargement of the posterolateral bundle after anterior cruciate ligament reconstruction

Journal of Orthopaedic Surgery ◽

10.1177/2309499019888811 ◽

2019 ◽

Vol 28 (1) ◽

pp. 230949901988881

Author(s):

Shinya Yanagisawa ◽

Masashi Kimura ◽

Keiichi Hagiwara ◽

Atsuko Ogoshi ◽

Tomotaka Yoneyama ◽

...

Keyword(s):

Ligament Reconstruction ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Posterolateral Bundle ◽

Bending Angle ◽

Cruciate Ligament Reconstruction ◽

Group A ◽

Anterior Cruciate ◽

Group B ◽

Group D

Purpose: The correlation between the graft bending angle (GBA) of the anteromedial bundle and posterolateral bundle after anterior cruciate ligament reconstruction (ACLR) and postoperative tunnel enlargement was evaluated. Methods: Two hundred fifty-eight patients (137 males, 121 females; mean age 27.3 years) who had undergone double-bundle ACLR were included. Computed tomographic scans of the operated knee were obtained at 2 weeks and 6 months postoperatively. The area of the tunnel aperture for femoral anteromedial tunnel (FAMT) and femoral posterolateral tunnel (FPLT) was measured; the area at 2 weeks after ACLR was subtracted from the area at 6 months after ACLR and then divided by the area at 2 weeks after ACLR. The femoral tunnel angles were obtained with Cobb angle measurements. The femoral tunnel angle in the coronal plane was measured relative to the tibial plateau (coronal GBA). On the median value, the patients were divided into two groups in each of FAMT and FPLT; those with a coronal GBA of FAMT of ≥27° were classified as group A, while those with a coronal GBA of <27° were classified as group B, those with a coronal GBA of FPLT of ≥23° were classified as group C, while those with a coronal GBA of<23° were classified as group D. Results: Group A included 129 knees, while group B included 129 knees. Groups A and B did not significantly differ regarding FAMT enlargement. Group C included 133 knees, while group D included 125 knees. The percentage of FPLT enlargement in group C was significantly smaller than that in group D ( p = 0.001). Conclusions: A steep coronal GBA of the FPLT after ACLR results in greater FPLT enlargement. The present findings suggest that surgeons should avoid creating a steep GBA of the FPLT in the outside-in technique.

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ACCELERATED REHABILITATION VERSUS CONVENTIONAL REHABILITATION AFTER ACL RECONSTRUCTION: A COMPARATIVE STUDY.

10.36106/ijsr/7805577 ◽

2021 ◽

pp. 76-77

Author(s):

Deepshikha Beniwal ◽

Sushmita Kushwaha ◽

Rajesh Rohilla ◽

Vishal Bhardwaj ◽

Bhupesh Goyal

Keyword(s):

Acl Reconstruction ◽

Knee Injury ◽

Cruciate Ligament ◽

Visual Analogue Score ◽

Acl Surgery ◽

Accelerated Rehabilitation ◽

Group A ◽

Anterior Cruciate ◽

Group B ◽

And Function

Objective: To know whether accelerated or conventional rehabilitation is effective after Anterior Cruciate ligament reconstruction. Material & Methods: 30 subjects were selected who fullled the predetermined inclusive and exclusive criteria. The subjects were divided into two groups, 15 in each group. Group A underwent Accelerated Rehabilitation and Group B underwent Conventional rehabilitation post ACL surgery. Visual analogue score(VAS) and Knee injury and osteoarthritis outcome Score(KOOS) was used as a measure of pain and function respectively. Results: Reduction in pain and improvement in function following rehabilitation is seen in both the groups. There is signicant difference in VAS(p<0.001) and KOOS(p<0.001) in group receiving accelerated rehabilitation following ACL reconstruction. Conclusion: Accelerated rehabilitation is effective over convential rehabilitaion post ACL surgery

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Graft Survivorship After Anterior Cruciate Ligament Reconstruction Based on Tibial Slope

The American Journal of Sports Medicine ◽

10.1177/03635465211049234 ◽

2021 ◽

pp. 036354652110492

Author(s):

Clemens Gwinner ◽

Milan Janosec ◽

Guido Wierer ◽

Michael Wagner ◽

Andreas Weiler

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Odds Ratio ◽

Cox Regression ◽

Cruciate Ligament ◽

Tibial Slope ◽

Acl Graft ◽

Group A ◽

Anterior Cruciate ◽

Group B

Background: Increased tibial slope (TS) is believed to be a risk factor for anterior cruciate ligament (ACL) tears. Increased TS may also promote graft insufficiency after ACL reconstruction. Purpose: To delineate the relationship between TS and single as well as multiple graft insufficiencies after ACL reconstruction. Study Design: Cohort study; Level of evidence 3. Methods: We retrospectively identified 519 patients who had sustained ACL graft insufficiency after primary or revision ACL reconstruction (1 graft insufficiency, group A; 2 graft insufficiencies, group B; and ≥3 graft insufficiencies, group C). In addition, a subgroup analysis was conducted in 63 patients who received all surgical interventions by 2 specialized high-volume, single-center ACL surgeons. TS was measured by an observer with >10 years of training using lateral knee radiographs, and intrarater reliability was performed. Multiple logistic and univariate Cox regression was used to assess the contribution of covariates (TS, age, sex, and bilateral ACL injury) on repeated graft insufficiency and graft survival. Results: The study included 347 patients, 119 female and 228 male, who were 24 ± 9 years of age at their first surgery (group A, n = 260; group B, n = 62; group C, n = 25). Mean TS was 9.8°± 2.7° (range, 3°-18°). TS produced the highest adjusted odds ratio (1.73) of all covariates for repeated graft insufficiency. A significant correlation was found between TS and the number of graft insufficiencies ( r = 0.48; P < .0001). TS was significantly lower in group A (9.0°± 2.3°) compared with group B (12.1°± 2.5°; P < .0001) and group C (12.0°± 2.6°; P < .0001). A significant correlation was seen between the TS and age at index ACL tear ( r = −0.12; P = .02) as well as time to graft insufficiency ( r = −0.12; P = .02). A TS ≥12° had an odds ratio of 11.6 for repeated ACL graft insufficiency. Conclusion: The current results indicate that patients with a markedly increased TS were at risk of early and repeated graft insufficiency after ACL reconstruction. Because the TS is rarely accounted for in primary and revision ACLR, isolated soft tissue procedures only incompletely address recurrent graft insufficiency in this subset of patients.

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Does Manual Drilling Improve the Healing of Bone–Hamstring Tendon Grafts in Anterior Cruciate Ligament Reconstruction? A Histological and Biomechanical Study in a Rabbit Model

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120911600 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091160

Author(s):

Matteo Maria Tei ◽

Giacomo Placella ◽

Marta Sbaraglia ◽

Roberto Tiribuzi ◽

Anastasios Georgoulis ◽

...

Keyword(s):

Acl Reconstruction ◽

Bone Healing ◽

Ultimate Load ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Tendon Graft ◽

Load To Failure ◽

Group A ◽

Anterior Cruciate ◽

Group B

Background: Heat necrosis due to motorized drilling during anterior cruciate ligament (ACL) reconstruction could be a factor in delayed healing at the bone–tendon graft interface. Hypothesis: The process of osteointegration could be enhanced using manual drilling. It reduces the invasiveness of mechanical-thermal stress normally caused by the traditional motorized drill bit. Study Design: Controlled laboratory study. Methods: ACL reconstruction using semitendinosus tendon autografts was performed in 28 skeletally mature female New Zealand white rabbits, which were randomly divided into 3 groups. In group A (n = 12), the tunnels were drilled using a motorized device; in group B (n = 12), the tunnels were drilled using a manual drill bit; and group C (n = 4) served as a control with sham surgical procedures. The healing process in the tunnels was assessed histologically at 2, 4, 8, and 12 weeks and graded according to the Tendon–Bone Tunnel Healing (TBTH) scoring system. In addition, another 25 rabbits were used for biomechanical testing. The structural properties of the femur–ACL graft–tibia complex, from animals sacrificed at 8 weeks postoperatively, were determined using uniaxial tests. Stiffness (N/mm) and ultimate load to failure (N) were determined from the resulting load-elongation curves. Results: The time course investigation showed that manual drilling (group B) had a higher TBTH score and improved mechanical behavior, reflecting better organized collagen fiber continuity at the bone–fibrous tissue interface, better integration between the graft and bone, and early mineralized chondrocyte-like tissue formation at all the time points analyzed with a maximum difference at 4 weeks (TBTH score: 5.4 [group A] vs 12.3 [group B]; P < .001). Stiffness (23.1 ± 8.2 vs 17.8 ± 6.3 N/mm, respectively) and ultimate load to failure (91.8 ± 60.4 vs 55.0 ± 18.0 N, respectively) were significantly enhanced in the specimens treated with manual drilling compared with motorized drilling ( P < .05 for both). Conclusion: The use of manual drilling during ACL reconstruction resulted in better tendon-to-bone healing during the crucial early weeks. Manual drilling was able to improve the biological and mechanical properties of bone–hamstring tendon graft healing and was able to restore postoperative graft function more quickly. Tunnel drilling results in bone loss and deficient tendon-bone healing, and heat necrosis after tunnel enlargement may cause mechanical stress, contributing to a delay in healing. Manual drilling preserved the bone stock inside the tunnel, reduced heat necrosis, and offered a better microenvironment for faster healing at the interface. Clinical Relevance: Based on study results, manual drilling could be used successfully in human ACL reconstruction, but further clinical studies are needed. A clinical alternative, called the original “all-inside” technique, has been developed for ACL reconstruction. In this technique, the femoral and tibial tunnels are manually drilled only halfway through the bone for graft fixation, reducing bone loss. Data from this study suggest that hamstring tendon–to–bone healing can be improved using a manual drilling technique to form femoral and tibial tunnels.

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Effect of Remnant-Preserving Reconstruction of Acute Anterior Cruciate Ligament Injuries in a Rabbit Model: Histological and Biomechanical Analysis

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2022.2992 ◽

2022 ◽

Vol 12 (5) ◽

pp. 897-906

Author(s):

XiaoChen Ju ◽

Hao Chai ◽

Sasirekha Krishnan ◽

Abinaya Jaisankar ◽

Murugan Ramalingam ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Articular Cartilage ◽

Acl Reconstruction ◽

Bone Healing ◽

Cruciate Ligament ◽

Cartilage Degeneration ◽

Remnant Preservation ◽

Model Animal ◽

Anterior Cruciate ◽

Articular Cartilage Degeneration

Acute anterior cruciate ligament (ACL) is a key structure that stabilizes knee joints. The objective of this research is to investigate the influence of ligament remnants preserved on the tendon-bone healing following ACL reconstruction and to examine postoperative articular cartilage degeneration in rabbit as a model animal. Sixty New Zealand rabbits are randomly divided into an ACL reconstruction without remnant preservation group (Group A; n = 30) or ACL reconstruction with remnant preservation group (Group B; n = 30). The expression of HIF-1α, VEGF, and micro vessel density (MVD) in the transplanted tendon was detected by immunohistochemical staining at week 6 and 12 after the operation. The signal intensity of the transplanted tendon was observed by MRI scanning, and the width of the bone tunnel was measured by CT scanning at week 6 and 12 after the operation. The graft biomechanics was tested 12 weeks after the operation. The JNK and MMP-13 expression levels were compared to analyze the cartilage degeneration of the knee at week 12 after the operation. The experimental results were analyzed and showed that the remnant-preserving ACL reconstruction is beneficial for bone healing of the tendon in rabbits, but ACL reconstruction with or without ligament remnants preserved will not affect knee articular cartilage degeneration post-surgery.

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The Effect of Remnant Preservation on Tibial Tunnel Enlargement in Anterior Cruciate Ligament Reconstruction with Polyethylene Terephthalate Artificial Ligament in a Large Animal Model

The Journal of Knee Surgery ◽

10.1055/s-0038-1675599 ◽

2018 ◽

Vol 32 (11) ◽

pp. 1094-1101

Author(s):

Jiangyu Cai ◽

Fang Wan ◽

Chengchong Ai ◽

Wenhe Jin ◽

Dandan Sheng ◽

...

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Bone Tunnel ◽

Control Group ◽

Micro Ct ◽

Tunnel Enlargement ◽

Artificial Ligament ◽

Remnant Preservation ◽

Anterior Cruciate

AbstractAn enlarged bone tunnel may affect the graft–bone integration and pose a problem for revision anterior cruciate ligament (ACL) surgery. The purpose of this study was to evaluate the effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with polyethylene terephthalate (PET) artificial ligament. Twenty-four skeletally mature male beagles underwent ACL reconstruction with PET artificial ligament for both knees. One knee was reconstructed with remnant preservation using sleeve technique (remnant group), while the contralateral was reconstructed without remnant preservation (control group). The animals were sacrificed at 1 day, 6 weeks, and 12 weeks after surgery for further evaluation including macroscopic observation, microcomputed tomography (micro-CT), histological assessment, and biomechanical testing. The remnant group had better synovial coverage than the control group at 6 and 12 weeks after surgery. The micro-CT analysis showed the tibial tunnel area (TTA) of the remnant group was significantly smaller and the bone volume/total volume fraction (BV/TV) value was higher than those of the control group at 6 and 12 weeks. Moreover, TTA and BV/TV at each time point were divided into three groups according to the different grade of synovial coverage. Significant association was observed between the synovial coverage degree and the TTA and BV/TV values. The histological assessment revealed that the interface width between the graft and host bone in the remnant group was smaller than that in the control group in the tibial tunnels at 6 and 12 weeks. Moreover, the remnant group had better failure load and stiffness than the control group at 12 weeks. The remnant preservation using sleeve technique could effectively promote the synovial coverage of the graft, decrease the risk of tibial tunnel enlargement by sealing the bone tunnel entrance, and enhance the biological environment for graft–bone healing after ACL reconstruction using PET artificial ligament. This technique provides a potential solution for bone tunnel enlargement following artificial ligament surgery for the acute ACL rupture in the clinical practice.

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