Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction with Remnant Tissue Preservation: Comparison with Conventional Procedure

Abstract

Introduction: No studies have evaluated the clinical utility of remnant preservation after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. The study hypotheses were as follows: (1) Subjective and functional clinical results may be comparable between anatomic double-bundle reconstructions that preserve the remnant tissue and those that resect the remnant tissue, (2) postoperative knee stability and the second-look arthroscopic evaluation may be significantly more favorable with the remnant preserving reconstruction, and (3) the degree of the initial graft coverage may significantly affect postoperative knee stability.

Methods: A total of 179 patients underwent anatomic double-bundle ACL reconstruction. Based on the Crain classification of ACL remnant tissue, 81 patients underwent the remnant-preserving procedure (group P) and the remaining 98 patients underwent the remnant-resecting procedure (group R). The patients were followed for two years or more.

Results: The subjective and functional clinical results were comparable between the two reconstruction procedures. Side-to-side anterior laxity was significantly less (P=0.0277) in group P (0.9 mm) than in group R (1.5 mm). During arthroscopic observations, results for group P were significantly better than for group R concerning postoperative laceration and fibrous tissue coverage of the grafts (P=0.0479).

Conclusion: Remnant preservation in anatomic double-bundle ACL reconstruction did not significantly improve subjective and functional results in the short-term evaluation, but it significantly improved postoperative knee stability. The degree of initial graft coverage significantly affected postoperative knee stability.