Techniqueandsignificanceofanteriorcruciateligamentreconstructionwithligamentremnantspreserved

ZHANG Shu; CHEN Chen; ZHANG Jun; WANG Wen; ZHOU Zhen-yu

doi:10.3969/j.issn.2095-252X.2013.09.010

Abstract：Objective To investigate the technique and signiifcance of anterior cruciate ligament ( ACL ) reconstruction with ligament remnants preserved. Methods From 2006 to 2009 a total of ACL injuries in 178 patients, which included 119 males and 59 females with an average age of 28 years old ( ranged, 17 to 46 ) were treated at our institution. The ACL injuries including complete disruption of ACL in 127 cases, partial disruption of ACL in 35 cases and laxity of ligament in 16 cases were conifrmed by arthroscopy. The ACL tibial aimer was in a medial and posterior position from the center of the remnants attached to the original ACL tibia. The tibial tunnel aimer was set at an angel of 45°, and the tibial tunnel was created by the guide pin. The suitable femoral tunnel aimer was placed through the tibial tunnel at 90° knee lfexion. The guide pin was drilled to a depth of 3 cm at the 10 to 11 o’clock position in the right knee and the 1 to 2 o’clock position in the left knee. The tibial or femoral remnants of ACL with complete disruption were not removed, and the tendon graft was pulled through the tibial or femoral remnants. The reconstructed ligaments were wrapped by the ligament remnants in a sleeve-like fashion. As to the ACL with a single bundle branch injured, the remnants of the ruptured bundle branch were preserved, and the other impaired and lax bundle branch should also be retained. For the obviously lax ACL, the tendon graft was pulled through the tibial or femoral attachment points with lax ligaments, which was then overlapped and twisted with the original ligament. Tendons were ifxed by the Rigidifx system at femoral extremities and the Intraifx system at tibial extremities. The Lysholm knee rating score was used to assess the surgical results after the surgery. Results All patients were followed up for a mean period of 19 months ( range;12-24 months ), and the stability of the knee joints was increased postoperatively. The Lysholm knee score was increased from ( 68.6±5.1 ) points preoperatively ( complete disruption:67.4±6.2, partial disruption:71.1±4.6, laxity of ligament:72.7±4.1 ) to ( 94.9±0.9 ) points postoperatively ( complete disruption:94.6±5.5, partial disruption:95.3±3.8, laxity of ligament:96.4±4.2 ) on average, with a growth of 26.3 points. A statistical analysis was done for the preoperative and postoperative Lysholm knee scores, and the results were statistically signiifcant ( P=0.0000<0.05 ). Conclusions ACL reconstruction with remnants preserved is conducive to the revascularization of the tendon graft, recovery of the proprioceptive sense, decrease of the amount of the synovial lfuid penetrating into the bone tunnel and the stability of the knee joint, so as to achieve satisfactory outcomes.