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Kim, Han, Yi, and Chun: Proprioceptive and Knee Joint Kinematics for Comparison of Remnant Preserved versus Non-remnant Anterior Cruciate Ligament Reconstruction Using Achilles Allograft
Clinical Article
The Korean Journal of Sports Medicine

The Korean Journal of Sports Medicine 2012; 30(2): 100-109.

Published online: 12 December 2012

DOI: https://doi.org/10.5763/kjsm.2012.30.2.100

Proprioceptive and Knee Joint Kinematics for Comparison of Remnant Preserved versus Non-remnant Anterior Cruciate Ligament Reconstruction Using Achilles Allograft

Kwang Mee Kim, PhD1, Joung Kyue Han, PhD2, Young Yi, MD3, Churl Hong Chun, MD3, 4

1Department of Nursing, Chodang University, Muan, Korea.

2Department of Sports Science, Chung-Ang University, Anseong, Korea.

3Department of Orthopaedic Surgery, Wonkwang University School of Medicine, Iksan, Korea.

4Institute of Wonkwang Medical Science, Iksan, Korea.

Correspondence: Churl Hong Chun. Department of Orthopaedic Surgery, Wonkwang University School of Medicine, 859 Muwang-ro, Iksan 570-711, Korea. Tel: +82-63-850-1254, Fax: +82-63-852-9329, cch@wonkwang.ac.kr

Received 23 April 2012       Revised 7 August 2012       Accepted 9 August 2012

Copyright © 2012 The Korean Society of Sports Medicine

(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

The purpose of remnant preserving technique in anterior cruciate ligament (ACL) reconstruction is to preserve mechanoreceptor and accelerate revascularization. In this study, we compared a group who underwent remnant preserving technique using Achilles tendon allograft with the other group of conventional ACL reconstruction in terms of proprioception, kinematic analysis, knee strength test and dynamic postural stability. Twenty-four patients were followed up for longer than 12 months after ACL reconstruction. They were separated into two groups; remnant preserving group (n=12) and non-remnant group (n=12). Proprioception test was conducted through joint position sense (JPS) and threshold to detection of passive motion. The remnant preserving group showed significantly less difference from the normal side than the non-remnant group. In kinematic analysis, there was statistically significant difference in peak flexion angle during the swing phase. However the 60° JPS, knee strength test, performance capacity test and dynamic postural stability did not showed the significant difference. Remnant preserving technique of ACL reconstruction was meaningful in preserving proprioception and the result showed akin to the unaffected gait.

Keywords: Anterior cruciate ligament, Remnant preserving technique, Proprioception

Figures and Tables

Fig. 1
Remnant preserving technique. (A) Femoral tunnel was positioned at the proximal part of bifurcate ridge preserving the remnant of anterior cruciate ligament (ACL). (B) Allograft was passed through beside the remnant of ACL. (C) Postoperative radiographs. *Remnant of ACL; †Achilles thedon allograft.
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Fig. 2
The method of measured joint position sense. (A) Put on Lokomat (Hocoma AG). (B) Flow diagram for the measured joint position sense. The subject is placed into the target angle by the Lokomat and is asked to memorize the angle. After being moved away from the target, the subject move the leg back to the target angle.
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Fig. 3
Primus-RS, BTE. Physical therapy equipment for multi-joint testing, orthopedic rehab, neuromuscular re-education, and advanced musculoskeletal athletic training of the upper & lower extremities and the core.
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Fig. 4
Biodex Stability System (BSS, Biodex Medical Systems Inc.) Consists of a movable balance platform that provides up to 20° of surface tilt in a 360° range of motion. The platform is interfaced with computer software that enables the device to serve as an objective assessment of balance.
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Fig. 5
Knee kinematics at average of each group. Group I was similar to the normal kinematics of the knee joint.
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Table 1
Characteristics of study subjects
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Group I: remnant preserving group, Group II: non-remnant group.

Table 2
Anterior cruciate ligament reconstruction rehabilitati on protocol
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ROM: range of motion.

Table 3
Isokinetic strengthening
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Group I: preservation of remnant group, Group II: no preservation group.

Table 4
Joint position sence and threshold to detection of passive motion
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Values are presented as mean±standard deviation.

Non OP: non operation, Group: remnant preserving group, Group II: non-remnant group.

*The opposite knee group that did not take surgery; †The difference between the operated groups and the opposite group; ‡p<0.05.

Table 5
Threshold to detection of passive motion
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Values are presented as mean±standard deviation.

Non OP: non operation, Group I: preservation of remnant group, Group II: no preservation group.

*Total opposite knee group that differences in surgical method is not; †The difference between the operated groups and the opposite knee group; ‡p<0.05.

Table 6
Dynamic postural stability
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Group I: remnant preserving group, Group II: non-remnant group.

p<0.05.

Table 7
Clinical result of performance capacities of each subject
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Group I: remnant preserving group, Group II: non-remnant group.

*p<0.05.

Table 8
Result of kinematic gait analysis
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Group I: remnant preserving group Group II: non-remnant group.

*p<0.05.

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