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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-08-2018 | Knee

Preservation of remnant with poor synovial coverage has no beneficial effect over remnant sacrifice in anterior cruciate ligament reconstruction

Authors: Bo Hyun Kim, Joong Il Kim, Osung Lee, Ki Woung Lee, Myung Chul Lee, Hyuk Soo Han

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2018

Abstract

Purpose

The purpose of the study was to evaluate the influence of synovial coverage of the remnant on clinical outcomes and graft healing in anterior cruciate ligament (ACL) reconstruction.

Methods

Seventy-five patients who underwent second-look arthroscopy after a single-bundle ACL reconstruction using autologous quadriceps tendon graft were included. The patients were divided into two groups according to whether the remnant was preserved (group P, n = 42) or sacrificed (group S, n = 33). Group P was further classified according to the degree of synovial coverage of the remnant on initial arthroscopic findings: group A (remnant fully covered with synovium, n = 15), group B (synovial coverage >50%, n = 15), and group C (coverage <50%, n = 12). Clinical outcomes including manual laxity tests, KT-2000 side-to-side difference, modified Lysholm score, Tegner activity score, and International Knee Documentation Committee score were evaluated pre-operatively and prior to the second-look arthroscopy. Graft tension, degrees of synovialization, and gross integrity were evaluated on second-look arthroscopic examination.

Results

There were no statistical differences in manual laxity tests, KT-2000 side-to-side difference, and clinical scores between groups P and S. In second-look arthroscopic examination, graft tension showed no difference between the two groups, but gross integrity and synovialization were significantly higher in group P (P = 0.032 and P = 0.008, respectively). In subgroup analysis, only group A showed higher grade regarding gross integrity and synovialization in comparison with group S (P = 0.007 and P < 0.001, respectively).

Conclusions

Preservation of remnant in ACL reconstruction showed no superiority concerning knee stability and clinical outcomes over remnant sacrificing at post-operative 1-year second-look arthroscopy. Preservation of remnant with good synovial coverage had a positive effect on graft synovialization and maintenance of graft integrity, but this effect was not observed in cases of a remnant with poor synovial coverage. When deciding whether to preserve the remnant or not, the degree of synovial coverage should be considered.

Level of evidence

III.

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Title: Preservation of remnant with poor synovial coverage has no beneficial effect over remnant sacrifice in anterior cruciate ligament reconstruction
Authors: Bo Hyun Kim
Joong Il Kim
Osung Lee
Ki Woung Lee
Myung Chul Lee
Hyuk Soo Han
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-017-4683-7

At a glance: The STEP trials

Springer Medicine

Preservation of remnant with poor synovial coverage has no beneficial effect over remnant sacrifice in anterior cruciate ligament reconstruction

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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