Comparison between Anterior cruciate ligament (ACL) remnant pull-out suture(tensioning) with ingle bundle reconstruction and ACL double reconstruction with autogenous hamstring graft:

摘要

Background: Remnant preservation during ACL reconstruction helps to facilitate graft healing , reinnervation and proprioceptive function. Several techniques have been described however these remnants are often left undisturbed during surgery. The aims of this study were to introduce a surgical technique, in which the preserved ACL remnant was tensioned during ACL reconstruction and to compare between ACL remnant tensioning with single bundle reconstruction and ACL double bundle reconstruction. Methods: Data of 42 patients who underwent ACL remnant tensioning with single bundle reconstruction and ACL double bundle reconstruction in 56 patients from Mar. 2004 till Mar. 2009 with minimum more than one year of follow-up were reviewed retrospectively. In both group , autogenous hamstring tendon were used for reconstruction. Double bundle reconstruction technique was try to make as normal anatomical reconstruction. In both group , femoral tunnel and pull out suture technique were done through a low anteromedial portal with more 120 degree flexion of the knee during arthroscopical procedure. Stability and function were assessed using Lachman test, Pivotshift test, side-to-side difference using KT-1000 arthrometer and Telos? device, The International Knee Documentation Committee (IKDC) and Orthopadische Arbeitsgruppe Knie (OAK) scores. All data were compared 42 patients with remnant tensioning group and 56 patients with double bundle reconstruction group which had no significant differences pertaining demographic distribution, timing of surgery and combined injuries. A significant ststistically difference was not observed between two groups in mechanical stability, clinical score. IKDC objective score was A ; 85.7%( 36 out of 42 patients),B ;9.5%( 4 ) C; 4.8%( 2 ) in remnant tensioning and single bundle reconstruction group and A ;75 % (42 out of 56) B; 23.2%( 13) C; 1% in double bundle reconstruction group. No significant differences were observed in Lachman test, pivot shift test test, and KT 1000 and other functional scores. Conclusion: Although a longer follow-up and further studies will be necessary before a conclusion can be reached, our preliminary using ACL remnant tensioning with single bundle reconstruction group was as same Results with ACL double bundle reconstruction . There was no difference in statistically in both group, but a little bit more cases in IKDC A and less than 2 mm side to side difference in KT 1000 arhrometer, which is a trend of better result in remnant tensioning group. Level of Evidence: Therapeutic study, Level III (retrospective, comparative study)