Remnant Preservation of the Primary Vertical Graft in Revision Anterior Cruciate Ligament Reconstruction

Jin-Hwan Ahn; Dong-Wook Son; Ji-Hyun Ahn; Dae-Won Park; Jun-Hyoung Park

doi:10.1177/23259671221143996

Remnant Preservation of the Primary Vertical Graft in Revision Anterior Cruciate Ligament Reconstruction

Orthop J Sports Med. 2023 Mar 20;11(3):23259671221143996. doi: 10.1177/23259671221143996. eCollection 2023 Mar.

Authors

Jin-Hwan Ahn¹, Dong-Wook Son², Ji-Hyun Ahn², Dae-Won Park², Jun-Hyoung Park²

Affiliations

¹ Department of Orthopaedic Surgery, Saeum Hospital, Seoul, Republic of Korea.
² Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Abstract

Background: The remnant preservation of a primary vertical graft in revision anterior cruciate ligament reconstruction (ACLR) can benefit anteroposterior stability. However, studies that address this concept are rare.

Purpose: To evaluate clinical outcomes of remnant preservation of primary vertical graft in revision ACLR.

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

Methods: A total of 74 patients with revision ACLR were included in this retrospective study. Remnant preservation revision ACLR was performed only in patients with primary vertical grafts. The patients were divided into 2 groups according to whether the primary remnant vertical graft was preserved (remnant group; n = 48) or absent or sacrificed (no-remnant group; n = 26). The remnant group was further divided according to the degree of remnant tissue: sufficiently preserved subgroup (graft coverage, ≥50%; n = 25) and insufficiently preserved subgroup (graft coverage, <50%; n = 23). Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective form, Lysholm score, Tegner activity scale, manual laxity tests, and side-to-side difference in anterior tibial translation on Telos stress radiographs.

Results: The mean time to final follow-up was 40.7 ± 16.8 months. The remnant group showed more improved results in the postoperative Lachman test and Telos side-to-side difference than did the no-remnant group (P = .017 and .016, respectively). The post hoc test revealed that the side-to-side difference in laxity in the sufficiently preserved subgroup significantly outperformed that in the no-remnant group (P = .001), although no significant difference existed between the insufficiently preserved and no-remnant subgroups (P = .850). The postoperative IKDC subjective form, Lysholm score, and Tegner activity scale did not show significant differences between the 2 groups (P = .480, .277, and .883, respectively).

Conclusion: The remnant preservation of the primary vertical graft in revision ACLR may result in better anteroposterior stability. However, subjective outcomes in the remnant group did not exceed that of the no-remnant group. The subgroup analysis revealed that only sufficiently preserved remnants demonstrated better anteroposterior stability.

Keywords: anterior cruciate ligament; reconstruction; remnant; revision; vertical graft.