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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2013

01-04-2013 | Knee

Remnant volume of anterior cruciate ligament correlates preoperative patients’ status and postoperative outcome

Authors: Takeshi Muneta, Hideyuki Koga, Young-Jin Ju, Masafumi Horie, Tomomasa Nakamura, Ichiro Sekiya

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2013

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Abstract

Purpose

A cohort study was conducted to evaluate the correlation of anterior cruciate ligament (ACL) remnant volume with preoperative status and postoperative outcome of the patients after a remnant-preserving double-bundle (DB) ACL reconstruction.

Methods

Eighty-eight patients of 105 unilateral DB anatomic ACL reconstructions performed between 2006 and 2008 were followed up for 24 months or more. They were evaluated with regard to preoperative knee laxity data under anaesthesia. Postoperative outcome was evaluated based on knee extension and flexion strength, manual laxity tests, KT measurements, etc. Overall knee condition and sports performance were evaluated with Lysholm knee score and subjective rating scale. Overall correlation of the remnant volume with the preoperative and postoperative evaluation was assessed. Then, the patients were divided into three subgroups based on the remnant volume (remnant volume: ≦30, 35–55 and ≦60 %). The evaluation was performed and analysed statistically among the three subgroups.

Results

Generally, preoperative laxity tests showed a weak correlation with the ACL remnant volume. Postoperative knee stability also indicated a weak correlation with the ACL remnant volume. Statistical analyses revealed that there were significant differences among the three groups regarding age at surgery, preoperative period, number of giving-way and preoperative KT measurements. Postoperatively, there were significant differences in Lachman test, KT measurements, Lysholm knee scale, subjective and sports performance recovery scores. As the clinical relevance, the study suggests that the remnant volume will be important as a background of preoperative condition and a predictor of operative outcome for each patient and that a remnant preserving surgery may not be simply better than a non-preserving technique with regard to subjective evaluation and sports performance recovery.

Conclusion

The preoperative condition of patients with ACL injury was different depending upon the remnant volume. The remnant volume was also weakly correlated with the postoperative outcome regarding objective stability and subjective recovery.

Level of evidence

Retrospective cohort study, Level III.
Literature
1.
go back to reference Ahn JH, Lee YS, Ha HC (2009) Anterior cruciate ligament reconstruction with preservation of remnant bundle using hamstring autograft: technical note. Arch Orthop Trauma Surg 129:1011–1015PubMedCrossRef Ahn JH, Lee YS, Ha HC (2009) Anterior cruciate ligament reconstruction with preservation of remnant bundle using hamstring autograft: technical note. Arch Orthop Trauma Surg 129:1011–1015PubMedCrossRef
2.
go back to reference Ayeni OR, Chahal M, Tran MN, Sprague S (2012) Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc doi:10.1007/s00167-011-1860-y Ayeni OR, Chahal M, Tran MN, Sprague S (2012) Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc doi:10.​1007/​s00167-011-1860-y
3.
go back to reference Bali K, Dhillon MS, Vasistha RK, Kakkar N, Chana R, Prabhakar S (2012) Efficacy of immunohistological methods in detecting functionally viable mechanoreceptors in the remnant stumps of injured anterior cruciate ligaments and its clinical importance. Knee Surg Sports Traumatol Arthrosc 20:75–80PubMedCrossRef Bali K, Dhillon MS, Vasistha RK, Kakkar N, Chana R, Prabhakar S (2012) Efficacy of immunohistological methods in detecting functionally viable mechanoreceptors in the remnant stumps of injured anterior cruciate ligaments and its clinical importance. Knee Surg Sports Traumatol Arthrosc 20:75–80PubMedCrossRef
4.
go back to reference Crain EH, Fithian DC, Paxton EW, Luetzow WF (2005) Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy 21:19–24PubMedCrossRef Crain EH, Fithian DC, Paxton EW, Luetzow WF (2005) Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy 21:19–24PubMedCrossRef
5.
go back to reference Daniel DM, Stone ML, Sachs R, Malcom L (1985) Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 13:401–407PubMedCrossRef Daniel DM, Stone ML, Sachs R, Malcom L (1985) Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 13:401–407PubMedCrossRef
6.
go back to reference Dhillon MS, Bali K, Vasistha RK (2010) Immunohistological evaluation of proprioceptive potential of the residual stump of injured anterior cruciate ligaments (ACL). Int Orthop 34:737–741PubMedCrossRef Dhillon MS, Bali K, Vasistha RK (2010) Immunohistological evaluation of proprioceptive potential of the residual stump of injured anterior cruciate ligaments (ACL). Int Orthop 34:737–741PubMedCrossRef
7.
go back to reference Georgoulis AD, Pappa L, Moebius U, Malamou-Mitsi V, Pappa S, Papageorgiou CO, Agnantis NJ, Soucacos PN (2001) The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc 9:364–368PubMedCrossRef Georgoulis AD, Pappa L, Moebius U, Malamou-Mitsi V, Pappa S, Papageorgiou CO, Agnantis NJ, Soucacos PN (2001) The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc 9:364–368PubMedCrossRef
8.
go back to reference Hara K, Mochizuki T, Sekiya I, Yamaguchi K, Akita K, Muneta T (2009) Anatomy of normal human anterior cruciate ligament attachments evaluated by divided small bundles. Am J Sports Med 37:2386–2391PubMedCrossRef Hara K, Mochizuki T, Sekiya I, Yamaguchi K, Akita K, Muneta T (2009) Anatomy of normal human anterior cruciate ligament attachments evaluated by divided small bundles. Am J Sports Med 37:2386–2391PubMedCrossRef
9.
go back to reference Hefti F, Drobny T, Hackenbruch W, Kipfer WC, Holzach P, Lakob RP, Müller WE, Stäubli H-U (1990) Evaluation of knee ligament injuries: the OAK and IKDC form. In: Jakob RP, Stäubli H-U (eds) The knee and the cruciate ligament. Springer, Berlin, pp 134–139 Hefti F, Drobny T, Hackenbruch W, Kipfer WC, Holzach P, Lakob RP, Müller WE, Stäubli H-U (1990) Evaluation of knee ligament injuries: the OAK and IKDC form. In: Jakob RP, Stäubli H-U (eds) The knee and the cruciate ligament. Springer, Berlin, pp 134–139
10.
go back to reference Kim SJ, Jo SB, Kim TW, Chang JH, Choi HS, Oh KS (2009) A modified arthroscopic anterior cruciate ligament double-bundle reconstruction technique with autogenous quadriceps tendon graft: remnant-preserving technique. Arch Orthop Trauma Surg 129:403–407PubMedCrossRef Kim SJ, Jo SB, Kim TW, Chang JH, Choi HS, Oh KS (2009) A modified arthroscopic anterior cruciate ligament double-bundle reconstruction technique with autogenous quadriceps tendon graft: remnant-preserving technique. Arch Orthop Trauma Surg 129:403–407PubMedCrossRef
11.
go back to reference Lee BI, Kwon SW, Kim JB, Choi HS, Min KD (2008) Comparison of clinical results according to amount of preserved remnant in arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft. Arthroscopy 24:560–568PubMedCrossRef Lee BI, Kwon SW, Kim JB, Choi HS, Min KD (2008) Comparison of clinical results according to amount of preserved remnant in arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft. Arthroscopy 24:560–568PubMedCrossRef
12.
go back to reference Lee BI, Min KD, Choi HS, Kwon SW, Chun DI, Yun ES, Lee DW, Jin SY, Yoo JH (2009) Immunohistochemical study of mechanoreceptors in the tibial remnant of the ruptured anterior cruciate ligament in human knees. Knee Surg Sports Traumatol Arthrosc 17:1095–1101PubMedCrossRef Lee BI, Min KD, Choi HS, Kwon SW, Chun DI, Yun ES, Lee DW, Jin SY, Yoo JH (2009) Immunohistochemical study of mechanoreceptors in the tibial remnant of the ruptured anterior cruciate ligament in human knees. Knee Surg Sports Traumatol Arthrosc 17:1095–1101PubMedCrossRef
13.
go back to reference Leung KK, Yu JK, Luo H, Ao YF, Wang JQ, Cui GQ, Hu YL, Gong X, Wang YJ, Zhang JY, Liu YL (2012) The position of the posterolateral bundle femoral tunnel during arthroscopic double-bundle anterior cruciate ligament reconstruction: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 20:75–80CrossRef Leung KK, Yu JK, Luo H, Ao YF, Wang JQ, Cui GQ, Hu YL, Gong X, Wang YJ, Zhang JY, Liu YL (2012) The position of the posterolateral bundle femoral tunnel during arthroscopic double-bundle anterior cruciate ligament reconstruction: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 20:75–80CrossRef
14.
go back to reference Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedCrossRef Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154PubMedCrossRef
15.
go back to reference Maeda S, Ishibashi Y, Tsuda E, Yamamoto Y, Toh S (2011) Intraoperative navigation evaluation of tibial translation after resection of anterior cruciate ligament remnants. Arthroscopy 27:959–964CrossRef Maeda S, Ishibashi Y, Tsuda E, Yamamoto Y, Toh S (2011) Intraoperative navigation evaluation of tibial translation after resection of anterior cruciate ligament remnants. Arthroscopy 27:959–964CrossRef
16.
go back to reference Mochizuki T, Muneta T, Nagase T, Shirasawa S, Akita KI, Sekiya I (2006) Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:356–361PubMedCrossRef Mochizuki T, Muneta T, Nagase T, Shirasawa S, Akita KI, Sekiya I (2006) Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:356–361PubMedCrossRef
17.
go back to reference Muneta T, Ezura Y, Sekiya I, Yamamoto H (1996) Anterior knee laxity and loss of extension after anterior cruciate ligament injury. Am J Sports Med 24:603–607PubMedCrossRef Muneta T, Ezura Y, Sekiya I, Yamamoto H (1996) Anterior knee laxity and loss of extension after anterior cruciate ligament injury. Am J Sports Med 24:603–607PubMedCrossRef
18.
go back to reference Muneta T, Sekiya I, Ogiuchi T, Yagishita K, Yamamoto H, Shinomiya K (1998) Objective factors affecting overall subjective evaluation of recovery after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 8:283–289PubMedCrossRef Muneta T, Sekiya I, Ogiuchi T, Yagishita K, Yamamoto H, Shinomiya K (1998) Objective factors affecting overall subjective evaluation of recovery after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 8:283–289PubMedCrossRef
19.
go back to reference Muneta T, Koga H, Mochizuki T, Ju YJ, Hara K, Nimura A, Yagishita K, Sekiya I (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 23:618–628PubMedCrossRef Muneta T, Koga H, Mochizuki T, Ju YJ, Hara K, Nimura A, Yagishita K, Sekiya I (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 23:618–628PubMedCrossRef
20.
go back to reference Muneta T, Hara K, Ju YJ, Mochizuki T, Morito T, Yagishita K, Sekiya I (2010) Revision anterior cruciate ligament reconstruction by double-bundle technique using multi-strand semitendinosus tendon. Arthroscopy 26:769–781PubMedCrossRef Muneta T, Hara K, Ju YJ, Mochizuki T, Morito T, Yagishita K, Sekiya I (2010) Revision anterior cruciate ligament reconstruction by double-bundle technique using multi-strand semitendinosus tendon. Arthroscopy 26:769–781PubMedCrossRef
21.
go back to reference Nakamae A, Ochi M, Deie M, Adachi N, Kanaya A, Nishimori M, Nakasa T (2010) Biomechanical function of anterior cruciate ligament remnants: how long do they contribute to knee stability after injury in patients with complete tears? Arthroscopy 26:1577–1585PubMedCrossRef Nakamae A, Ochi M, Deie M, Adachi N, Kanaya A, Nishimori M, Nakasa T (2010) Biomechanical function of anterior cruciate ligament remnants: how long do they contribute to knee stability after injury in patients with complete tears? Arthroscopy 26:1577–1585PubMedCrossRef
23.
go back to reference Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49PubMed
24.
go back to reference van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26(Suppl):S2–S12PubMed van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26(Suppl):S2–S12PubMed
25.
go back to reference Yamazaki J, Muneta T, Koga H, Sekiya I, Ju YJ, Morito T, Yagishita K (2011) Radiographic description of femoral tunnel placement expressed as intercondylar clock time in double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19:418–423PubMedCrossRef Yamazaki J, Muneta T, Koga H, Sekiya I, Ju YJ, Morito T, Yagishita K (2011) Radiographic description of femoral tunnel placement expressed as intercondylar clock time in double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19:418–423PubMedCrossRef
26.
go back to reference Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025PubMedCrossRef Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025PubMedCrossRef
27.
go back to reference Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H (2010) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26(Suppl):S21–S34PubMed Yasuda K, Tanabe Y, Kondo E, Kitamura N, Tohyama H (2010) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26(Suppl):S21–S34PubMed
28.
go back to reference Yasuda K, Kondo E, Kitamura N, Kawaguchi Y, Kai S, Tanabe Y (2012) A pilot study of anatomic double-bundle anterior cruciate ligament reconstruction with ligament remnant tissue preservation. Arthroscopy 28:343–353PubMedCrossRef Yasuda K, Kondo E, Kitamura N, Kawaguchi Y, Kai S, Tanabe Y (2012) A pilot study of anatomic double-bundle anterior cruciate ligament reconstruction with ligament remnant tissue preservation. Arthroscopy 28:343–353PubMedCrossRef
29.
go back to reference Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, Bonanzinga T, Lopomo N, Bignozzi S, Marcacci M (2011) Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc 19:390–397PubMedCrossRef Zaffagnini S, Bruni D, Marcheggiani Muccioli GM, Bonanzinga T, Lopomo N, Bignozzi S, Marcacci M (2011) Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up. Knee Surg Sports Traumatol Arthrosc 19:390–397PubMedCrossRef
Metadata
Title
Remnant volume of anterior cruciate ligament correlates preoperative patients’ status and postoperative outcome
Authors
Takeshi Muneta
Hideyuki Koga
Young-Jin Ju
Masafumi Horie
Tomomasa Nakamura
Ichiro Sekiya
Publication date
01-04-2013
Publisher
Springer-Verlag
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-012-2023-5

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