Does the tibial remnant of the anterior cruciate ligament promote ligamentization?

• Published in: The knee 2016-12, Vol.23 (6), p.1133-1142
• Main Authors: Lee, Byung-Ill, Kim, Byoung-Min, Kho, Duk-hwan, Kwon, Sai-Won, Kim, Hyeung-June, Hwang, Hyun-Ryong
• Format: Article
• Language: English
• Subjects: ACL reconstruction; Adult; Anterior cruciate ligament; Anterior Cruciate Ligament - diagnostic imaging; Anterior Cruciate Ligament - pathology; Anterior Cruciate Ligament Injuries - diagnostic imaging; Anterior Cruciate Ligament Injuries - pathology; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - methods; Cohort Studies; Conflicts of interest; Female; Hamstring Tendons - transplantation; Humans; Knee; Ligamentization; Ligaments; Magnetic Resonance Imaging; Male; Methods; NMR; Noise; Nuclear magnetic resonance; Organ Sparing Treatments - methods; Orthopedics; Remnant-preserving technique; Retrospective Studies; Skin & tissue grafts; Surgery; Surgical outcomes; Tendons; Treatment Outcome
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2016.09.008

Abstract Background The purpose of this study was to clarify the difference in ligamentization between the remnant-preserving (RP) and remnant-sacrificing (RS) techniques in anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI). Methods A retrospective comparative study was carried out on 98 patients undergoing ACL reconstruction using either an RP (n = 56) or RS (n = 42) technique. MRI was performed at one of four time points postoperatively, and the signal intensity of the ACL graft was analyzed using the signal to noise quotient (SNQ) ratio and inter-bundle high signal intensity, along with an analysis of the survival rate of remnant tissue. Results The mean SNQ ratio of grafted tendons in the RP group was significantly higher than that seen in the RS group in the proximal and middle regions 2–4 months after surgery ( P < 0.05) and was significantly lower than that seen in the RS group in all regions at 12–18 months ( P < 0.05). The inter-bundle high signal intensity was observed more frequently in the RP group (73.7%) than in the RS group (26.3%) at 2–4 months. Tibial remnants were observed on postoperative MRI regardless of when MRI was conducted. Conclusion The ACL graft of the RP group showed higher signal intensity in the early stage and lower signal intensity in the late stage compared to that of the RS group by MRI evaluation. The ligamentization of grafts in the RP group proceeded more quickly. Preserving the remnant in ACL reconstruction appears to have a positive effect on ligamentization.