Subscribe to RSS
Return to Sports after ACL Reconstruction with Resection or Remnant-Preserving Technique[*]Article in several languages: português | English
Objectives To analyze the results of anterior cruciate ligament (ACL) reconstruction with remnant-preserving versus remnant-resecting technique, concerning the return to pre-lesion activity level.
Methods The present retrospective cohort study has assessed adults > 18 years old who underwent ACL anatomical reconstruction between 2010 and 2014. The main outcomes assessed were: level of physical activity (4-point scale), sports participation rate, ACL rerupture defined as documented lesion requiring revision surgery and the numeric pain scale rate (NPSR).
Results A total of 83 individuals were included in the study, with a mean age of 31.8 years old and follow-up mean time of 4.2 years after the surgery. A total of 34 patients underwent ACL reconstruction with remnant-preserving technique, and 49 without remnant preservation. No statistically significant difference was found between groups in all outcomes assessed: level of physical activity before the lesion and after the surgery, ACL rerupture rates and postoperative pain level. Subgroup analysis has shown a statistically significant decrease in the activity level in both groups. The most practiced sport was football; 72% of patients in the remnant group have resumed football activity versus 52.6% of the control group.
Conclusion Based in these findings, the comparison between ACL reconstruction with remnant preserving technique and remnant resecting technique has shown no differences concerning the return to prelesion activity level.
Keywordsanterior cruciate ligament - rupture - anterior cruciate ligament reconstruction - return to sport
* Work developed by the Knee Group from Ortocity, São Paulo, SP, Brazil, and the Knee Group, Orthopedics and Traumatology Department, Universidade Federal de São Paulo, São Paulo (UNIFESP/EPM), SP, Brazil.
Received: 24 January 2019
Accepted: 21 August 2019
07 February 2020 (online)
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil
- 1 Tie K, Chen L, Hu D, Wang H. The difference in clinical outcome of single-bundle anterior cruciate ligament reconstructions with and without remnant preservation: A meta-analysis. Knee 2016; 23 (04) 566-574
- 2 Dhillon MS, Bali K, Vasistha RK. Immunohistological evaluation of proprioceptive potential of the residual stump of injured anterior cruciate ligaments (ACL). Int Orthop 2010; 34 (05) 737-741
- 3 Song GY, Zhang J, Li X, Chen XZ, Li Y, Feng H. Acute anterior cruciate ligament reconstruction with an augmented remnant repair: a comparative macroscopic and biomechanical study in an animal model. Arthroscopy 2014; 30 (03) 344-351
- 4 Kazusa H, Nakamae A, Ochi M. Augmentation technique for anterior cruciate ligament injury. Clin Sports Med 2013; 32 (01) 127-140
- 5 Muneta T, Koga H, Nakamura T. , et al. A new behind-remnant approach for remnant-preserving double-bundle anterior cruciate ligament reconstruction compared with a standard approach. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3743-3749
- 6 Gohil S, Annear PO, Breidahl W. Anterior cruciate ligament reconstruction using autologous double hamstrings: a comparison of standard versus minimal debridement techniques using MRI to assess revascularisation. A randomised prospective study with a one-year follow-up. J Bone Joint Surg Br 2007; 89 (09) 1165-1171
- 7 da Silveira Franciozi CE, Ingham SJ, Gracitelli GC, Luzo MV, Fu FH, Abdalla RJ. Updates in biological therapies for knee injuries: anterior cruciate ligament. Curr Rev Musculoskelet Med 2014; 7 (03) 228-238
- 8 Luzo MV, Franciozi CE, Rezende FC, Gracitelli GC, Debieux P, Cohen M. Anterior cruciate ligament - updating article. Rev Bras Ortop 2016; 51 (04) 385-395
- 9 Hu J, Qu J, Xu D, Zhang T, Zhou J, Lu H. Clinical outcomes of remnant preserving augmentation in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014; 22 (09) 1976-1985
- 10 Song GY, Zhang H, Zhang J. , et al. The anterior cruciate ligament remnant: to leave it or not?. Arthroscopy 2013; 29 (07) 1253-1262
- 11 Stata, Corporation. Stata statistical software: release 7.0. 2001
- 12 Borbon CA, Mouzopoulos G, Siebold R. Why perform an ACL augmentation?. Knee Surg Sports Traumatol Arthrosc 2012; 20 (02) 245-251
- 13 Dejour D, Ntagiopoulos PG, Saggin PR, Panisset JC. The diagnostic value of clinical tests, magnetic resonance imaging, and instrumented laxity in the differentiation of complete versus partial anterior cruciate ligament tears. Arthroscopy 2013; 29 (03) 491-499
- 14 Bali K, Dhillon MS, Vasistha RK, Kakkar N, Chana R, Prabhakar S. 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 2012; 20 (01) 75-80
- 15 Sha L, Xie G, Zhao S, Zhao J. A morphologic and quantitative comparison of mechanoreceptors in the tibial remnants of the ruptured human anterior cruciate ligament. Medicine (Baltimore) 2017; 96 (05) e6081
- 16 Demirağ B, Ermutlu C, Aydemir F, Durak K. A comparison of clinical outcome of augmentation and standard reconstruction techniques for partial anterior cruciate ligament tears. Eklem Hastalik Cerrahisi 2012; 23 (03) 140-144
- 17 Pujol N, Colombet P, Potel JF. , et al. French Arthroscopy Society (SFA). Anterior cruciate ligament reconstruction in partial tear: selective anteromedial bundle reconstruction conserving the posterolateral remnant versus single-bundle anatomic ACL reconstruction: preliminary 1-year results of a prospective randomized study. Orthop Traumatol Surg Res 2012; 98 (08) S171-S177
- 18 Ma T, Zeng C, Pan J, Zhao C, Fang H, Cai D. Remnant preservation in anterior cruciate ligament reconstruction versus standard techniques: a meta-analysis of randomized controlled trials. J Sports Med Phys Fitness 2017; 57 (7-8): 1014-1022
- 19 Takazawa Y, Ikeda H, Kawasaki T. , et al. ACL Reconstruction Preserving the ACL Remnant Achieves Good Clinical Outcomes and Can Reduce Subsequent Graft Rupture. Orthop J Sports Med 2013; 1 (04) 2325967113505076
- 20 Ardern CL, Taylor NF, Feller JA, Webster KE. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 2014; 48 (21) 1543-1552
- 21 Waldén M, Hägglund M, Magnusson H, Ekstrand J. ACL injuries in men's professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. Br J Sports Med 2016; 50 (12) 744-750