Comparison of Clinical Results and Second-Look Arthroscopic Findings of Remnant Preserving versus Non-Remnant Preserving Technique after Anterior Cruciate Ligament Reconstruction Using Achilles Allograft

Keun Churl Chun; Jae Sun Hwang; Kwang Mee Kim; Da Hee Kim; Churl Hong Chun

doi:10.4055/jkoa.2013.48.5.366

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Chun, Hwang, Kim, Kim, and Chun: Comparison of Clinical Results and Second-Look Arthroscopic Findings of Remnant Preserving versus Non-Remnant Preserving Technique after Anterior Cruciate Ligament Reconstruction Using Achilles Allograft

Original Article

Journal of the Korean Orthopaedic Association 2013; 48(5): 366-374.

Published online: 25 October 2013

DOI: https://doi.org/10.4055/jkoa.2013.48.5.366

Comparison of Clinical Results and Second-Look Arthroscopic Findings of Remnant Preserving versus Non-Remnant Preserving Technique after Anterior Cruciate Ligament Reconstruction Using Achilles Allograft

Keun Churl Chun, M.D., Jae Sun Hwang, M.D., Kwang Mee Kim, Ph.D.^*, Da Hee Kim, P.T., Churl Hong Chun, M.D., Ph.D.

Department of Orthopedic Surgery, Wonkwang University School of Medicine, Iksan, Korea.

^*Department of Nursing, Chodang University, Muan, Korea.

Correspondence to: Churl Hong Chun, M.D., Ph.D. Department of Orthopedic Surgery, Wonkwang University School of Medicine, 460 Iksan-daero, Iksan 570-749, Korea. TEL: +82-63-859-1360, FAX: +82-63-852-9329, cch@wonkwang.ac.kr

Received 19 May 2013 Revised 27 July 2013 Accepted 17 August 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted for evaluation of clinical uses of anterior cruciate ligament (ACL) reconstruction with an Achilles allograft using the remnant technique by comparison and analysis stability, functional assessment and results of second-look arthroscopy between the remnant technique and the non-remnanat technique.

Materials and Methods

A total of 48 patients who underwent ACL reconstruction using an Achilles allograft were selected and divided into two groups depending on the presence of remnant. The preserving group included 26 patients and non-preserving group included 22 patients. The two groups were compared and analyzed with regarding to stability (Stress view Lachman test, pivot shift test), functional assessment (International Knee Documentation Committee, Lysholm score, Tegner score, single hoop test, shuttle turn, carioca test), and the result of second-look arthroscopy (study design: prosepective cohort study).

Results

In the final result, the remnant group showed significant improvement in the Tegner and carioca tests compared with the non-remnant group (p<0.05). In second-look arthroscopy, the remnant group showed better coverage of synovium (p<0.05).

Conclusion

ACL reconstruction with an Achilles allograft using the remnant technique showed better results in functional assessment and finding in second-look arthroscopy compared with the non-remnant technique group.

Keywords: anterior cruciate ligament, remnant preserving technique, functional assessment, second-look arthroscopy, synovial coverage

Figures and Tables

Figure 1

Intraoperative arthroscopic image (anteromedial portal) showing anterior cruciate ligament (ACL) reconstruction using the remnant tissue preserving technique on the right knee. (A) The femoral tunnel was positioned at the proximal part of the bifurcate ridge preserving the remnant of the ACL. (B) Allograft was passed to the side of the remnant of ACL. (C) Postoperative radiographs. Arrows: remnant tissue of ACL.

Figure 2

Anterior cruciate ligament (ACL) reconstruction using the non-remnant preserving technique on the left knee. (A) Complete rupture of the ACL at the femoral attachment site. (B) Reconstructed ACL. (C) Postoperative radiographs.

Figure 3

Second look arthroscopic findings of anterior cruciate ligament (ACL) reconstruction using the remnant preserving technique (postoperative 26 months). (A) Good revascularization was observed. (B) Good synovial coverage was observed. (C) Normal tension was observed. Arrow: remnant tissue of ACL.

Figure 4

Second look arthroscopic finding of anterior cruciate ligament reconstruction using the non-remnant preserving technique (postoperative 25 months). (A) Good revascularization was observed. (B) Good synovial coverage was observed. However, compared to the results using the remnant preserving technique, the synovium coverage was thin. (C) Normal tension was observed.

Table 1

Comparison of Stability at Last Follow-Up

Values are presented as mean±standard deviation or number (%). Group I: remnant preserving group, Group II: non-remnant preserving group. ^*Side-to-side difference in the instrumented anterior drawer test using the Telos stress device.

Table 2

Comparison of Functional Outcome

Values are presented as mean±standard deviation or number (%). Group I: remnant preserving group, Group II: non-remnant preserving group. IKDC: International Knee Documentation Committee.

Table 3

Tegner Score

Values are presented as number or mean±standard deviation. Group I: remnant preserving group, Group II: non-remnant preserving group.

Table 4

Comparison of Functional Outcomes

Values are presented as mean±standard deviation. Group I: remnant preserving group, Group II: non-remnant preserving group.

Table 5

Comparison of Graft Tension and Synovial Coverage

Values are presented as number (%). Group I: remnant preserving group, Group II: non-remnant preserving group.

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