Effects of Preserving Anatomically Positioned and Adequate Remnant ACL Tissue in Double-Bundle ACL Reconstruction

Dai Sato; Masayuki Inoue; Yasuhiko Kasahara; Hiroki Hamano; Ryota Suzuki; Eiji Kondo; Norimasa Iwasaki

doi:10.1177/23259671231162389

Effects of Preserving Anatomically Positioned and Adequate Remnant ACL Tissue in Double-Bundle ACL Reconstruction

Orthop J Sports Med. 2023 Apr 21;11(4):23259671231162389. doi: 10.1177/23259671231162389. eCollection 2023 Apr.

Authors

Dai Sato¹, Masayuki Inoue¹, Yasuhiko Kasahara¹, Hiroki Hamano¹, Ryota Suzuki¹, Eiji Kondo², Norimasa Iwasaki³

Affiliations

¹ Department of Orthopaedic Surgery, NTT East Japan Sapporo Hospital, Sapporo, Japan.
² Centre for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan.
³ Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.

Abstract

Background: The advantages of remnant tissue preservation in anterior cruciate ligament (ACL) reconstruction (ACLR) remain controversial.

Hypothesis: It was hypothesized that a large amount of remnant tissue, especially if anatomically positioned, would improve patient-reported outcomes and second-look graft appearance after preserved double-bundle ACLR (DB-ACLR).

Study design: Cohort study; Level of evidence, 3.

Methods: This retrospective study included 89 consecutive patients who underwent unilateral remnant-preserving DB-ACLR using 2 hamstring tendon autografts. The authors categorized the arthroscopic findings into 3 groups according to the location and volume of the ACL remnant tissue in the femoral notch: (1) anatomical attachment (group AA; n = 34); (2) nonanatomical attachment (group NA; n = 33); and (3) no remnant (group NR; n = 22). Based on second-look arthroscopy, the reconstructed graft was graded as excellent, fair, or poor. Patient-reported outcomes were evaluated at 2 years after surgery using the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Japanese Anterior Cruciate Ligament Questionnaire-25 (JACL-25).

Results: The AA and NA groups had a significantly shorter time from injury to surgery compared with the NR group (P = .0165). Considering the second-look arthroscopic findings, the authors found a significant difference in synovial coverage of the grafts between the 3 groups (P = .0018). There were no significant differences in the overall KOOS and JACL-25 score among the 3 groups; however, the KOOS-Sport and Recreation and KOOS-Quality of Life subscale scores were significantly higher in the AA group compared with the NA and NR groups (P = .0014 and .0039, respectively). The JACL-25 score for middle- to high-speed flexion and extension was significantly better in the AA group versus the NR group (P = .0261).

Conclusion: This study showed that preserving anatomically positioned and adequate remnant tissue during DB-ACLR improved second-look graft appearance and KOOS-Sport and Recreation and KOOS-Quality of Life scores.

Keywords: anterior cruciate ligament reconstruction; outcomes; patient-reported; remnant preservation; second-look arthroscopic evaluation.