A prospective, randomized, controlled study on anterior cruciate ligament reconstruction with or without remnant preservation

Abstract

Objective To compare the clinical outcomes of patients who underwent remnant-preserved anterior cruciate ligament (ACL) reconstruction with those who underwent conventional ACL reconstruction (ACLR). Methods From January 2010 to October 2012, 93 eligible patients suffered from ACL injuries were randomly allocated into remnant-preserved group (ACLR with remnant preservation; n=48; Male/Female=34/14; Left/Right=25/23) and conventional group (ACLR without remnant preservation; n=45; Male/Female=33/12; Left/Right=22/23). The mean age of patients, time from injury to surgery, rates of combined meniscal injuries, and medial collateral ligament injury all showed no significant difference between the two groups preoperatively. All the patients underwent ACL reconstruction using 4-strand hamstring autografts. The postoperative assessments included knee functional scales (IKDC grade classification and Lysholm score), stability examinations (Lachman, pivot-shift, and KT-1000 arthometer), proprioceptive evaluations, and second-look arthroscopy. Results The average follow-up time was 25.4 months for the remnant-preserved group and 25.2 months for the conventional group. For IKDC grade classification, there were 32 patients with grade A, 9 with grade B, 1 with grade C in remnant-preserved group, whereas 30 with grade A, 8 with grade B, 2 with grade C in conventional group, which showed no significant difference between the two groups. Moreover, the Lysholm score (95.9±5.2 vs. 95.4±1.7), Lachman test, pivot-shift test, KT-1000 arthometer (1.1±1.2 mm vs. 1.2±0.9 mm), proprioceptive evaluations (joint position sense: 3.6°±1.8° vs. 3.9°±2.2°) all showed no significant differences between the two groups. Additionally, the synovial coverage of grafted tendon under second-look arthroscopy was categorized as grade A in 11, grade B in 6, grade C in 2, grade D in 2 in remnant-preserved group, whereas grade A in 10, grade B in 5, grade C in 2, and grade D in 2 in conventional group, which still showed no significant difference. Conclusion In terms of the knee functional scales, stability examinations, joint position sense and graft synovial coverage, remnant-preserved ACLR group showed no superiority to the conventional ACLR group. Key words: Arthroscopy; Anterior cruciate ligament reconstruction; Randomized controlled trials as topic