Anterior Cruciate Ligament Reconstruction Using Single hamstring tendonAutograft with Remnant Preservation:Comparison of Outcomes According to the Lengthof Remnant Tissue
Department of Orthopedics,Union Hospital of Fujian Medical University
Abstract:Objective To compare clinical outcomes between groups of patients who underwent ACL reconstruction with single hamstring tendonautograft divided according to lengthof ACL remnant and investigate effect of remnant preservation on outcomes of ACL reconstruction.Methods A total of 100 patients who underwent ACL reconstruction with single hamstring tendonautograft were retrospectively reviewedin the department of orthopedics of our hospital from January 2016 to February 2018.Patients were divided into three groups according to proportion of length of remnant tissue of injured ACL covering part of reconstructed ACL to total length of reconstructed ACL.Group A included 40 patients with no remnant,group B consisted of 35 patients with remnant of <50%,group C consisted of 25 patients with remnant of >50%.The results of knee function score,stability test and joint movement ability test (including return to activity and near-return to activity)were investigated and compared among the three groups at the last follow-up.Results Patients in the three groups follow-up duration were 25~47 months,with an average duration of (34.50±10.42) months.There was no statistically significant difference between three groups regarding preoperative IKDC subjective score,Lysholm score and Tegner score.At the last follow-up,the above scores in the three groups were all higher than that before surgery,and there was no statistical difference between the three groups in Lysholm knee score,while the subjective IKDC score (including physical activity and function) and Tegner score in group C were significantly better than those in group A and B.At the last follow-up,the results of Lachman,ADT and Pivot shift test in the three groups were all higher than those before the operation,and the paired comparison of results of Lachman,ADT and axial shift test among the three groups showed no statistical significance.At the last follow-up,there were no statistically significant differences in knee range of motion,hop test and near-return to activity among the three groups.However,patients of group C had significantly better outcomes inreturn to activity than those ingroup A and B.There was no significant difference in postoperativecomplications between the three groups.Results ACL reconstructionusing single hamstring tendonautograftwith remnant preservation did not provide better anterior stability compared with conventional ACL reconstruction.However,preservation of remnant of >50% led to more improved activity-related clinical outcomes than no remnant preservation.In cases with substantial remnant tissue of injured ACL remaining,reconstruction of ACL while preserving as much remnant tissue as possible is recommended.
陈敏,林佳俊,刘文革. 保留残端长度对自体腘绳肌腱单束重建前交叉韧带的效果影响[J]. 实用骨科杂志, 2020, 26(8): 693-699.
Chen Min,Lin Jia Jun,Liu Wenge. Anterior Cruciate Ligament Reconstruction Using Single hamstring tendonAutograft with Remnant Preservation:Comparison of Outcomes According to the Lengthof Remnant Tissue. sygkzz, 2020, 26(8): 693-699.
[1]Nematollahi M,Razeghi M,Tahayori B,et al.The role of Anterior Cruciate Ligament in the control of posture;possible neural contribution[J].NeurosciLett,2017(659):120-123.
[2]Kosy J,Mandalia V.Anteriorcruciateligament mechanoreceptors and their potentialimportance in remnant-preserving reconstruction:areview of basic science and clinical findings[J].J Knee Surg,2018,31(8):736-746.
[3]Sha L,Zhao J.A morphologic and quantitative comparison of mechanoreceptors in the tibial remnants of the ruptured human anterior cruciate ligament[J].Medicine(Baltimore),2017,96(5):e6081.
[4]李磊,吴昊.前交叉韧带保留残端重建术治疗前交叉韧带损伤的研究[J].实用骨科杂志,2019,25(12):1067-1072.
[5]Ouanezar H,Blakeney WG,Fernandes LR,et al.Clinical outcomes ofsingleanteromedial bundle biologic augmentation technique foranterior cruciate ligament reconstruction with consideration of tibialremnant size[J].Arthroscopy,2018,34(3):714-722.
[6]Courtney CA,Atre P,Foucher KC,et al.Hypoesthesia after anterior cruciate ligament reconstruction:The relationship between proprioception and vibration perception deficits in individuals greater than one year post-surgery[J].Knee,2019,26(1):194-200.
[7]Osti M,ElAttal R,Doskar W,et al.High complication rate following dynamic intraligamentary stabilization for primary repair of the anterior cruciateligament[J].Knee Surgery Sports Traumatol Arthrosc,2019,27(1):29-36.
[8]Outerbridge RE.The etiology of chondromalacia patellae[J].J Bone Joint Surg(Br),1961,43(4):752-757.
[9]Kim MK,Lee SR,Ha JK,et al.Comparison of second-look arthroscopic findings and clinical results according to the amount of preserved remnant in anterior cruciate ligament reconstruction[J].Knee,2014,21(3):774-778.
[10]刘志成,李雁,张其亮.前交叉韧带重建后膝关节周围屈伸肌力与运动功能的变化[J].中国组织工程研究,2018,22(27):4393-4399.
[11]Dallo I,Chahla J,Mitchell JJ,et al.Biologic approaches for the treatment of partial tears of the anterior cruciate ligament:a current concepts review[J].Orthop J Sports Med,2017,5(1):2325967116681724.
[12]吴冰,朱伟民,欧阳侃,等.自体腘绳肌腱移植重建前交叉韧带后移植物的组织学研究[J].中国修复重建外科杂志,2018,32(7):873-879.
[13]Ahmad SS,Schreiner AJ,Hirschmann MT,et al.Dynamic intraligamentary stabilization for ACL repair:a systematic review[J].Knee Surg Sports Traumatol Arthrosc,2019,27(1):13-20.
[14]Hoogeslag RAG,Brouwer RW,Boer BC,et al.Acuteanterior cruciate ligament rupture:repair or reconstruction? Two-year results of a randomized controlled clinical trial[J].Am J Sports Med,2019,47(3):567-577.
[15]Meister M,Koch J,Amsler F,et al.ACL suturing using dynamic intraligamentarystabilisation showing good clinical outcome but a high reoperation rate:a retrospective independent study[J].Knee Surg Sports Traumatol Arthrosc,2018,26(2):655-659.
[16]Hoogeslag RAG,Brouwer RW,de Vries AJ,et al.Efficacy of nonaugmented,static augmented,and dynamic augmented suture repair of the ruptured anterior cruciate ligament:asystematic review of the literature[J].Am J Sports Med,2020,26(4):036354652090469.
[17]Cabuk H,Cabuk KF.Mechanoreceptors of the ligaments and tendons around the knee[J].Clin Anat,2016,29(6):789-795.
[18]Kim BH,Kim JI,Lee O,et al.Preservation of remnant with poor synovial coverage has no beneficial effect over remnant sacrifice in anterior cruciate ligament reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2018,26(8):2345-2352.
[19]Takahashi T,Kimura M,Hagiwara K,et al.The effect of remnant tissue preservation in anatomic double-bundle ACL reconstruction on knee stability and graft maturation[J].J Knee Surg,2019,32(6):565-576.
[20]姚望,潘剑英,曾春.保残重建前交叉韧带对膝关节运动学特征的影响[J].中华关节外科杂志(电子版),2020,14(1):24-32.
[21]Tie K,Chen L,Hu D,et al.The difference in clinical outcome of single-bundle anterior cruciate ligament reconstructions with and without remnant preservation:A meta-analysis[J].Knee,2016,23(5):566-574.
[22]Muneta T,Koga H,Ju YJ,et al.Remnant volume of anterior cruciate ligament correlates preoperative patients' status and postoperative outcome[J].Knee Surg Sports Traumatol Arthrosc,2013,21(4):906-913.
[23]魏民,毕胜,刘玉杰,等.胫骨残端长度对前交叉韧带重建术后本体觉恢复的影响[J].中国骨伤,2015,28(7):609-614.
[24]Lee BI,Kim CH,Jang BW.Preservation of the tibialremnant in anterior cruciate ligament reconstruction may improve postoperative proprioceptive function[J].Orthopedics,2020,43(4):e231-e236.
[25]Li B,Wang YT,Bai LH,et al.Changes of mechanoreceptors in differentstate remnants of ruptured anterior cruciate ligament[J].Int Orthop,2018,42(11):2613-2618.
[26]Samaan MA,Facchetti L,Pedoia V,et al.Cyclops lesions are associated with altered gait patterns and medial knee joint cartilage degeneration at 1 year after ACL-reconstruction[J].J Orthop Res,2017,35(10):2275-2281.
[27]Pinto FG,Thaunat M,Daggett M,et al.Hamstring contracture afterACL reconstruction is associated with an increased risk of Cyclopssyndrome[J].Orthop J Sports Med,2017,5(1):2325967116684121.
[28]Wang HD,Wang FS,Gao SJ,et al.Remnant preservation technique versus standard technique for anterior cruciate ligament reconstruction:a meta-analysis of randomized controlled trials[J].J Orthop Surg Res,2018,13(1):231.
[29]Sonnery-Cottet B,Saithna A,Quelard B,et al.Arthrogenic muscle inhibition after ACL reconstruction:a scoping review of the efficacy of interventions[J].Br J Sports Med,2019,53(5):289-298.