Significance of preserving anterior cruciate ligament stump for the stability of knee joint

doi:10.3969/j.issn.2095-4344.1033

Abstract

Abstract:

BACKGROUND: Anterior cruciate ligament preservation reconstruction has been introduced to improve clinical outcomes and biotherapy. However, the effect of stump preservation and injury influence, its impact on reconstruction, and the efficacy of this technique remain uncertain.

OBJECTIVE: To investigate the effect of arthroscopic anterior cruciate ligament reconstruction on the recovery of proprioception in patients with anterior cruciate ligament injury by preserving ligament stump.

METHODS:A retrospective analysis of 80 patients with anterior cruciate ligament injury admitted at the Department of Sports Medicine in Shengjing Hospital of China Medical University between January 2016 and March 2017 was performed. All patients underwent arthroscopic reconstruction of anterior cruciate ligament with autologous parasagittal tendon as a graft, including 40 cases of preserving-remnant, and 40 cases of removing-remnant. All patients were followed up for more than 12 months to evaluate the knee joint function and recovery of proprioception.

RESULTS AND CONCLUSION: (1) The postoperative Lysholm and International Knee Documentation Committee scores were significantly improved in both groups, and the postoperative forward movement of the tibia, threshold to detection of passive activity, passive angle reproduction were all significantly reduced compared with the baseline (P < 0.05). (2) In the preserving-remnant group, the Lysholm and International Knee Documentation Committee scores at postoperative 3 months were significantly higher than those in the removing-remnant group, and threshold to detection of passive activity, and passive angle reproduction were lower than those in the removing-remnant group (P < 0.05). (3) There were no significant differences in the forward movement of the tibia by Kneelax system and plantar pressure at 3 and 12 months postoperatively between two groups (P > 0.05). (4) In summary, preserving-remnant in arthroscopic anterior cruciate ligament reconstruction can improve the early recovery of proprioception, and obtain satisfactory clinical efficacy.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Proprioception, Anterior Cruciate Ligament, Tissue Engineering

CLC Number:

R453
R615

Feng Xinyuan, Bai Lunhao. Significance of preserving anterior cruciate ligament stump for the stability of knee joint [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(4): 525-531.

Figures/Tables 5

References

[1] Duthon VB, Barea C, Abrassart S, et al. Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2006;14(3):204-213.

[2] Wu B, Zhao Z, Li S, et al. Preservation of remnant attachment improves graft healing in a rabbit model of anterior cruciate ligament reconstruction. Arthroscopy. 2013;29(8):1362-1371.

[3] Song GY, Zhang J, Li X, et al. Biomechanical and Biological Findings Between Acute Anterior Cruciate Ligament Reconstruction With and Without an Augmented Remnant Repair: A Comparative in Vivo Animal Study. Arthroscopy. 2016;32(2):307-319.

[4] Zhang L, Qi J, Zeng Y, et al. Proprioceptive Changes in Bilateral Knee Joints Following Unilateral Anterior Cruciate Ligament Injury in Cynomolgus Monkeys. Med Sci Monit. 2018;24:105-113.

[5] Andonovski A, Topuzovska S, Samardziski M, et al. The Influence of Anterior Cruciate Ligament Remnant on Postoperative Clinical Results in Patients with Remnant Preserving Anterior Cruciate Ligament Reconstruction. Open Access Maced J Med Sci. 2017;5(5):624-629.

[6] Lowe WR, Warth RJ, Davis EP, et al. Functional Bracing After Anterior Cruciate Ligament Reconstruction: A Systematic Review. J Am Acad Orthop Surg. 2017;25(3): 239-249.

[7] Kirizuki S, Matsumoto T, Ueha T, et al. The Influence of Ruptured Scar Pattern on the Healing Potential of Anterior Cruciate Ligament Remnant Cells. Am J Sports Med. 2018; 46(6):1382-1388.

[8] Naraoka T, Kimura Y, Tsuda E, et al. Is Remnant Preservation Truly Beneficial to Anterior Cruciate Ligament Reconstruction Healing? Clinical and Magnetic Resonance Imaging Evaluations of Remnant-Preserved Reconstruction. Am J Sports Med. 2017;45(5):1049-1058.

[9] 宋关阳.有关膝关节保留残端前交叉韧带重建的相关研究[D]. 北京:清华大学,2016.

[10] 于长隆,曲绵域.实用运动医学[M].北京:北京大学医学出版社, 2003:482-483.

[11] Wirth B, Liffert F, de Bruin ED. Development and evaluation of a German version of the Lysholm score for measuring outcome after anterior cruciate ligament injuries. Sportverletz Sportschaden. 2011;25(1):37-43.

[12] Hefti F, Müller W, Jakob RP, et al. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc. 1993;1(3-4):226-234.

[13] 黄萍,钱念东,齐进,等.膝骨关节炎患者膝关节置换术后足底压力研究[J].中国运动医学杂志,2018,37(3):197-201

[14] Bastin J, Calvin S, Montagne G. Muscular proprioception contributes to the control of interceptive actions. J Exp Psychol Hum Percept Perform. 2006;32(4):964-972.

[15] Dhillon MS, Bali K, Prabhakar S. Proprioception in anterior cruciate ligament deficient knees and its relevance in anterior cruciate ligament reconstruction. Indian J Orthop. 2011;45(4): 294-300.

[16] 陈均源,王华军,罗斯敏,等.前交叉韧带重建本体感觉恢复影响因素分析[J].中国矫形外科杂志,2016,24(24):2264-2268.

[17] Kim HJ, Lee JH, Lee DH. Proprioception in Patients With Anterior Cruciate Ligament Tears: A Meta-analysis Comparing Injured and Uninjured Limbs. Am J Sports Med. 2017;45(12): 2916-2922.

[18] 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(5):737-741.

[19] Bali K, Dhillon MS, Vasistha RK, et al. 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(1):75-80.

[20] Riemann BL, Lephart SM. The Sensorimotor System, Part II: The Role of Proprioception in Motor Control and Functional Joint Stability. J Athl Train. 2002;37(1):80-84.

[21] Lee BI, Min KD, Choi HS, et al. Immunohistochemical study of mechanoreceptors in the tibial remnant of the ruptured anterior cruciate ligament in human knees. Knee Surg Sports Traumatol Arthrosc. 2009;17(9):1095-1101.

[22] Kosy JD, Mandalia VI. Anterior Cruciate Ligament Mechanoreceptors and their Potential Importance in Remnant-Preserving Reconstruction: A Review of Basic Science and Clinical Findings. J Knee Surg. 2018;31(8): 736-746.

[23] Ahn JH, Wang JH, Lee YS, et al. Anterior cruciate ligament reconstruction using remnant preservation and a femoral tensioning technique: clinical and magnetic resonance imaging results. Arthroscopy. 2011;27(8):1079-1089.

[24] Crain EH, Fithian DC, Paxton EW, et al. Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy. 2005;21(1):19-24.

[25] Muneta T, Koga H. Anterior cruciate ligament remnant and its values for preservation. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2016;7:1-9.

[26] Zhang S, Matsumoto T, Uefuji A, et al. Anterior cruciate ligament remnant tissue harvested within 3-months after injury predicts higher healing potential. BMC Musculoskelet Disord. 2015;16:390.

[27] Angoules AG, Mavrogenis AF, Dimitriou R, et al. Knee proprioception following ACL reconstruction; a prospective trial comparing hamstrings with bone-patellar tendon-bone autograft. Knee. 2011;18(2):76-82.

[28] Furlanetto TS, Peyré-Tartaruga LA, do Pinho AS, et al. Proprioception, body balance and functionality in individuals with acl reconstruction. Acta Ortop Bras. 2016;24(2):67-72.

[29] 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(9):1165-1171.

[30] Ahn JH, Lee SH, Choi SH, et al. Magnetic resonance imaging evaluation of anterior cruciate ligament reconstruction using quadrupled hamstring tendon autografts: comparison of remnant bundle preservation and standard technique. Am J Sports Med. 2010;38(9):1768-1777.

[31] Li B, Wang GB, Wang YF, et al. Effects of pre-operative knee laxity on clinical outcomes after partial anterior cruciate ligament reconstruction. Knee. 2018;25(3):445-452.

[32] An KO, Park GD, Lee JC. Effects of acceleration training 24 weeks after anterior cruciate ligament reconstruction on proprioceptive and dynamic balancing functions. J Phys Ther Sci. 2015;27(9):2825-2828.

[33] Park JH, Jeong WK, Lee JH, et al. Postural stability in patients with anterior cruciate ligament tears with and without medial meniscus tears. Knee Surg Sports Traumatol Arthrosc. 2015; 23(1):240-245.

[34] Nakamae A, Ochi M, Deie M, et al. Biomechanical function of anterior cruciate ligament remnants: how long do they contribute to knee stability after injury in patients with complete tears? Arthroscopy. 2010;26(12):1577-1585.

[35] Takahashi T, Kondo E, Yasuda K, et al. Effects of Remnant Tissue Preservation on the Tendon Graft in Anterior Cruciate Ligament Reconstruction: A Biomechanical and Histological Study. Am J Sports Med. 2016;44(7):1708-1716.

[36] Tie K, Chen L, Hu D, et al. The difference in clinical outcome of single-bundle anterior cruciate ligament reconstructions with and without remnant preservation: A meta-analysis. Knee. 2016;23(4):566-574.

[37] 许锦煌,黄建荣,尹萍,等.保留残端对前交叉韧带重建术后恢复的临床意义[J].中国临床解剖学杂志,2015,33(5):584-587.

[38] Lee BI, Kwon SW, Kim JB, et al. Comparison of clinical results according to amount of preserved remnant in arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft. Arthroscopy. 2008;24(5):560-568.

[39] Hexter AT, Thangarajah T, Blunn G, et al. Biological augmentation of graft healing in anterior cruciate ligament reconstruction. Bone Joint J. 2018;100-B(3):271-284.

[40] Lee BI, Min KD, Choi HS, et al. Arthroscopic anterior cruciate ligament reconstruction with the tibial-remnant preserving technique using a hamstring graft. Arthroscopy. 2006;22(3): 340. e1-7.

[41] Weninger P, Wepner F, Kissler F, et al. Anatomic Double-Bundle Reinsertion After Acute Proximal Anterior Cruciate Ligament Injury Using Knotless PushLock Anchors. Arthrosc Tech. 2015;4(1):e1-6.