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Anterior Cruciate Ligament Reconstruction With Remnant Preservation

Background: Efforts still need to be made to improve the technique for surgical anterior cruciate ligament reconstruction (ACLR). Several reports have claimed that ACLR with the remnant preservation technique can obtain satisfactory clinical results. Purpose: To compare the short-term clinical outcome of remnant-preserving ACLR with standard ACLR. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A prospective, randomized controlled study was performed in 90 consecutive patients who underwent ACLR with the remnant preservation technique (study group, n = 45) or the standard technique (control group, n = 45) with the use of a 4-strand allograft. The Lysholm score, International Knee Documentation Committee (IKDC) grade, stability assessments (Lachman test, pivot-shift test, and KT-1000 arthrometer side-to-side differences), synovial coverage of the graft, and proprioception measurements were evaluated preoperatively and at the last follow-up. Results: All consecutive patients who were screened for eligibility between August 2008 and April 2010 were enrolled and followed clinically. There were 39 patients in the study group and 41 in the control group who were followed for at least 2 years (mean follow-up, 25.7 months). At the last follow-up, the median Lysholm score was 99 in the study group and 95 in the control group (P = .07). The IKDC grade was A or B in 38 patients in the study group and 40 patients in the control group (P = .548). Lachman test results were negative in 38 patients in the study group and 40 patients in the control group (P = .862), and the pivot-shift test result was negative in 37 patients in the study group and 36 patients in the control group (P = .523). The mean KT-1000 arthrometer side-to-side difference averaged 1.6 ± 1.7 mm in the study group and 1.8 ± 1.8 mm in the control group (P = .694). Second-look arthroscopy was performed to evaluate synovial coverage of the graft. Normal or nearly normal synovial coverage, graded as A or B, was 71.4% (20/28) in the study group and 70.4% (19/27) in the control group (P = .966). The passive angle reproduction test result at 15° was 3.6° ± 1.8° in the study group and 3.9° ± 2.2° in the control group (P = .739). Conclusion: This short-term study showed that, in terms of stability, synovial coverage, and proprioception recovery, remnant preservation ACLR using an allograft had no evident advantages in clinical outcome over the standard technique.