Is anterior cruciate ligament preservation surgery better than reconstructing both bundles?

Abstract

Rupture of the anterior cruciate ligament (ACL) is one of the most common ligamentous injuries of the knee, with an incidence of 35 out of 100,000. An ACL reconstruction is now a routine procedure. Generally, good outcomes are expected from the surgery, with return to preinjury level of sports activity in most patients. Debate, however, continues regarding the advantages of preserving the ACL remnant and augmenting it with a graft as opposed to debridement of the remnant in a standard ACL reconstruction. The purpose of this article is to consider the scientific basis of ACL preservation surgery (remnant preservation and selective bundle reconstruction) and to compare the outcomes between an ACL-preserving surgery and a double-bundle reconstruction. Both techniques provide anteroposterior laxity control and some degree of control on rotational laxity. Although superior Lysholm and subjective International Knee Documentation Committee (IKDC) scores have been documented with double-bundle reconstructions, remnant-preserving procedures have several advantages and seem to have a valuable contribution either on single-bundle, selective, and double-bundle reconstructions. Based on our experience, we recommend the remnant preserving technique. However, longer follow-up is necessary to ascertain which procedure could restore the normal knee kinematics, thus providing better clinical outcomes.