Single-Bundle Isometric ACL Reconstruction with Remnant Preservation

Abstract

Remnant-preserving anterior cruciate ligament (ACL) reconstruction showed advantages of promoting ligamentization, graft hypertrophy, cell proliferation, revascularization, regeneration of proprioceptive organs, synovialization, and even clinical outcomes. Though the central anatomical single bundle ACL reconstruction is favorable [1], the isometric ACL reconstruction still has the advantage of low tension on the graft [2]. So, an isometric single-bundle ACL reconstruction technique named I.D.E.A.L. described by Pearle et al. [3] became popular in recent years. Sometimes the ACL remnant tendon couldn’t be identified as AM or PL bundle but has intact femoral and tibial attachment. When we perform isometric ACL reconstruction in these kinds of cases, it will be difficult to create the femoral tunnel without destroy the ACL remnant tendon. Though Ahn et al. [4] and Lee et al. [5] have reported posterolateral portal technique using a 70° arthroscope or trans-septal portal technique, Jung et al. [6] and Seong et al. [7] have reported remnant re-tension technique for remnant-preserving isometric ACL reconstruction, it is still instrumental depending on and challenging even for experienced surgeons. We usually perform isometric ACLR I n this kind of cases with a technique named “Peek.”