Abstract
Purpose This is a systematic review and meta-analysis of current evidence that aims at comparing the clinical outcomes of remnant-preserving anterior cruciate ligament reconstruction (ACLR) and standard ACLR. Methods A systematic review of randomized controlled studies and cohort studies comparing remnant-preserving ACLR with standard ACLR with a minimum level of evidence of II was performed. Studies were included by strict inclusion and exclusion criteria. Extracted data were summarized as preoperative conditions, postoperative clinical outcomes, and postoperative complications. When feasible, meta-analysis was performed with RevMan5.3 software. Study methodological quality was evaluated with the modified Coleman methodology score (CMS). Results Eleven studies (n = 466 remnant-preserving and n = 536 standard) met the inclusion criteria. The mean modified CMS for all included studies was 85.8 (range: 77–92 on a 100-point scale). In total, 466 patients underwent remnant-preserving ACLR by 3 different procedures: standard ACLR plus tibial remnant tensioning (n = 283), selective-bundle augmentation (n = 49), and standard ACLR plus tibial remnant sparing (n = 134). Remnant-preserving ACLR provided a superior outcome of postoperative knee anterior stability (WMD = −0.42, 95% CI, −0.66, −0.17; P < 0.01) and Lysholm score (WMD = 2.01, 95% CI, 0.53 to 3.50; P < 0.01). There was no significant difference between the two groups with respect to second-look arthroscopy (OR = 1.38, 95% CI, 0.53, 3.62; P=0.51), complications (OR = 1.24 95% CI, 0.76, 2.02; P=0.39), International Knee Documentation Committee (IKDC) subject scores, IKDC grades, Lachman test, and pivot-shift test. Summary/conclusion Remnant-preserving ACLR promotes similar graft synovial coverage and revascularization to standard ACLR. Equivalent or superior postoperative knee stability and clinical scores were observed for remnant-preserving ACLR compared with standard ACLR. No significant difference in the total complication rate between the groups was evident.
Highlights
Anterior cruciate ligament (ACL) reconstruction (ACLR) has become a popular and effective surgery for the management of ACL injury [1,2,3,4]
A systematic search of 4 databases, namely, PubMed, EMBASE, Medline Ovid, and Cochrane Library, was performed by two authors independently on December 10, 2018. e base terms used in each search included “anterior cruciate ligament remnant,” “ACL augmentation,” “ACL preservation,” “ACL stump,” “selective anterior cruciate ligament reconstruction (ACLR),” and “ACL remnant reconstruction.” e levels of evidence, namely, I and II, were reviewed for study inclusion
Evidence; studies that included subjective and objective outcomes; written in English; use of human subjects; and a study publication or in-press online date between January 1, 2000, and December 10, 2018. e exclusion criteria for this article are as follows: the follow-up period was less than one year; level III or IV evidence; study that does not directly compare the outcome of remnant-preserving ACLR and standard ACLR; and operative interventions were not described in the article
Summary
Anterior cruciate ligament (ACL) reconstruction (ACLR) has become a popular and effective surgery for the management of ACL injury [1,2,3,4]. To achieve better knee stability and clinical outcomes, remnant-preserving ACLR, with its potential advantages of promoting faster graft revascularization and maturation, has been studied and compared to standard ACLR. Many histological and animal studies have confirmed that ACL remnants retain a well-vascularized synovial sheet, numerous fibroblasts and myofibroblasts, and mechanoreceptors [7,8,9,10,11,12,13]. Some authors claim that remnants can accelerate the process of synovial coverage and revascularization and enhance the biomechanical properties of grafts in animals [8, 14]. Many studies [15,16,17,18,19,20,21,22,23,24,25] have reported inconsistent clinical outcomes when comparing remnant-preserving ACLR to standard ACLR. Some studies [17, 22] have reported better arthroscopic
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