Tendon-bone healing in anterior cruciate ligament reconstruction with and without remnant preservation / 中国组织工程研究

BACKGROUND: Whether remnant preservation can improve tendon-bone healing remains a controversy. Experiments were designed to evaluate whether remnant preservation has the biological advantage of promoting tendon-bone healing by histology and imaging. OBJECTIVE: To investigate the effect of preservation of ligament stump on tendon-bone healing in anterior cruciate ligament reconstruction. METHODS: Forty New Zealand rabbits were randomly divided into two groups: anterior cruciate ligament reconstruction group without remnant preservation (group A) and anterior cruciate ligament reconstruction group with remnant preservation (group B), with 20 rabbits in each group. Achilles tendon was selected as the graft, and the bilateral anterior cruciate ligaments of all the rabbits were cut off. In group A, the anterior cruciate ligament stump was completely removed. In group B, the tibia stump was cut off from the femoral stop, and the tibia stump was retained. According to the position of the anterior cruciate ligament of the normal rabbits, the tibia and the femoral canal were selected for reconstruction. At 6 and 12 weeks after surgery, the expression of vascular endothelial growth factor and hypoxia inducible factor-1α was detected by immunohistochemistry. Graft microvessel density was detected by CD34 immunohistochemical staining. The signal intensity of tendon and the width of bone tunnel were observed by MRI and CT. RESULTS AND CONCLUSION: (1) The percentage of hypoxia inducible factor-1α and vascular endothelial growth factor positive cells in group B was significantly higher than that in group A at 6 weeks after operation (P 0.05). (2) At 6 weeks after operation, the expansion of bone tunnel in group B was significantly lower than that in group A, and the signal intensity of tendon graft was lower in group B than that in group A (P 0.05). (3) In this experiment, in the early stage of ligament reconstruction, the anterior cruciate ligament reconstruction with remnant preservation is superior to the anterior cruciate ligament reconstruction without remnant preservation in terms of graft revascularization and reduction of bone tunnel expansion, showing some biological advantages.

Proprioception and Clinical Results of Anterolateral Single-Bundle Posterior Cruciate Ligament Reconstruction with Remnant Preservation

PURPOSE: To evaluate the clinical and radiological results and proprioception following anterolateral single-bundle posterior cruciate ligament (PCL) reconstruction with remnant preservation for PCL injury. MATERIALS AND METHODS: Twenty patients with an isolated PCL injury (16 males and 4 females) were included in this study. The mean follow-up period was 61 months (> or =24 months) and the mean age of the patients was 36 years. Knee joint instability was evaluated using posterior drawer stress radiography. Knee function, level of activities, and individual satisfaction were assessed using the Lysholm knee score, Tegner activity score, and 2000 International Knee Documentation Committee (IKDC) score. Knee proprioception was assessed using an isokinetic machine. RESULTS: The mean ligament laxity assessed using the posterior drawer stress radiography was improved from 10.8-3.2 mm. The mean Lysholm knee score was improved from 70.0-88.9 points, and the mean Tegner activity score was improved from 2.7-6.2 points. Individual satisfaction assessed using the IKDC score was improved from 62.7-85.4 points (p<0.05). Knee proprioception was not significantly different between the treated and the uninjured knees. CONCLUSIONS: Single-bundle PCL reconstruction with remnant preservation for PCL injury exhibited satisfactory outcomes regarding functional outcome, joint stability, and proprioception.

Proprioceptive and Strength Comparison of Remnant Preserved versus Conventional Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

Reconstruction of the anterior cruciate ligament (ACL) restores knee stability. The remnant preserving technique was developed to preserve mechanoreceptor function, promote revasularzation and facilitate ligamentation. The purpose of this study was to analyze the clinical results of ACL reconstruction with remnant preserving. Between October in 2008 and September in 2009, 40 patients underwent ACL reconstruction using auto graft-hamstring tendon. On the basis of the ACL's condition patients were divided into 2 groups. In the trial group (preserved remnant group, PRG; n=20), there were 20 males with an average age of 26.2 years. In the control group (no remnant group, NRG; n=20) were 20 males with an average of age 27.1 years. We measured concentric peak torque of the knee extensors and flexors at 60degrees/s and 180degrees/s on an Isokinetic dynamometry. Proprioceptive functions have been assessed using Joint position sense and threshold to detection of passive motion. Dynamic postural stability was measured as a stability index in the anterior-posterior and medial-lateral planes with the Biodex Stability System. All tests were measured post-operative 1year. We found significant difference between the PRG and NRG for Joint position sense at 15degrees (2.40degrees+/-1.00degrees vs. 3.36degrees+/-0.95degrees; p=0.0145) and threshold to detect passive motion at 45degrees (2.02degrees+/-0.59degrees vs. 3.12degrees+/-0.94degrees; p=0.0213). But, we found no significant difference between the groups for the test results of the dynamic postural stability and knee strength. Therefore, preservation of the remnant ACL reconstruction is helpful in preserving the proprioception and function to stabilize the knee.