Efficacy of Remnant-preserving Anterior Cruciate Ligament Reconstruction versus Standard Anterior Cruciate Ligament Reconstruction by Arthroscopy: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 CHENJun-yuan , YANGjie , LIJie-ruo , WANGHua-jun , LUOSi-min ,  ZHAZhen-gang

Department of Bone and Joint Surgery, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China;

Corresponding author：

ZHAZhen-gang, Email: zhzgg@vip.163.com

Keywords：

Anterior cruciate ligament; Arthroscopy; Remnant-preserving; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160026

Video：

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Objective To systematically review the efficacy of remnant-preserving anterior cruciate ligament (ACL) reconstruction versus standard ACL reconstruction by arthroscopy. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 11, 2015), CBM, CNKI, VIP and WanFang Data were electronically searched to collect randomized controlled trials (RCTs) about remnant-preserving ACL reconstruction versus standard ACL reconstruction by arthroscopy from inception to Nov. 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 5 RCTs involving 295 knees were included. The results of meta-analysis showed that: KT-1000 measurement and tibial tunnel enlargement at final follow-up in the remnant-preserving ACL reconstruction group were less than that of the standard ACL reconstruction group with significant difference (MD=-0.36, 95%CI -0.63 to -0.10, P=0.007; MD=-0.44, 95%CI -0.71 to -0.16, P=0.002). There were no significant differences between both groups in rate of negative pivot shift test, rate of negative Lachman test, Lysholm scores, IKDC subjective scores and joint range of motion (all P values >0.05). Conclusion Arthroscopic remnant-preserving ACL reconstruction can prevent the tibia tunnel enlargement and improve the stability of the knee joint postoperatively, but cannot improve the short-term postoperative functional scores. Due to the limited quality and quantity of the included studies, more large-scale and high quality RCTs are needed to verify the above conclusion.

Citation： CHENJun-yuan, YANGjie, LIJie-ruo, WANGHua-jun, LUOSi-min, ZHAZhen-gang. Efficacy of Remnant-preserving Anterior Cruciate Ligament Reconstruction versus Standard Anterior Cruciate Ligament Reconstruction by Arthroscopy: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(2): 153-159. doi: 10.7507/1672-2531.20160026 Copy

1.	Janssen KW, Orchard JW, Driscoll TR, et al. High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003-2004 to 2007-2008:time for an anterior cruciate ligament register by Scandinavian model?. Scand J Med Sci Sports, 2012, 22(4):495-501.
2.	Buller LT, Best MJ, Baraga MG, et al. Trends in Anterior Cruciate Ligament Reconstruction in the United States. Orthop J Sports Med, 2015, 3(1):2325967114563664.
3.	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.
4.	Yasuda K, Kondo E, Kitamura N, et al. A pilot study of anatomic double-bundle anterior cruciate ligament reconstruction with ligament remnant tissue preservation. Arthroscopy, 2012, 28(3):343-353.
5.	Demirag B, Ermutlu C, Aydemir F, et al. A comparison of clinical outcome of augmentation and standard reconstruction techniques for partial anterior cruciate ligament tears. Eklem Hastalik Cerrahisi, 2012, 23(3):140-144.
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 oneyear follow-up. J Bone Joint Surg Br, 2007, 89(9):1165-1171.
7.	Hong L, Li X, Zhang H, et al. Anterior cruciate ligament reconstruction with remnant preservation:a prospective, randomized controlled study. Am J Sports Med, 2012, 40(12):2747-2755.
8.	Pujol N, Colombet P, Potel JF, et al. Anterior cruciate ligament reconstruction in partial tear:selective anteromedial bundle reconstruction conserving the posterolateral remnant versus singlebundle anatomic ACL reconstruction:preliminary 1-year results of a prospective randomized study. Orthop Traumatol Surg Res, 2012, 98(8):171-177.
9.	Zhang Q, Zhang S, Cao X, et al. The effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with hamstring autograft:A prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2014, 22(1):166-173.
10.	Sabat D, Kundu K, Arora S, et al. Tunnel widening after anterior cruciate ligament reconstruction:a prospective randomized computed tomography——based study comparing 2 different femoral fixation methods for hamstring graft. Arthroscopy, 2011, 27(6):776-783.
11.	Xu Y, Ao Y, Wang J, et al. Relation of tunnel enlargement and tunnel placement after single-bundle anterior cruciate ligament reconstruction. Arthroscopy, 2011, 27(7):923-932.
12.	Zysk SP, Fraunberger P, Veihelmann A, et al. Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc, 2004, 12(2):98-103.
13.	孙磊, 吴波, 田敏, 等. 兔保留与切除残迹前交叉韧带重建生物力学的比较. 中华关节外科杂志, 2013, 7(1):81-85.
14.	Weiler A, Peters G, Maurer J, et al. Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging. A two-year study in sheep. Am J Sports Med, 2001, 29(6):751-761.
15.	Papalia R, Franceschi F, Vasta S, et al. Sparing the anterior cruciate ligament remnant:is it worth the hassle?. Br Med Bull, 2012, 104(1): 91-111.
16.	高加智, 孙磊. 保留残迹对骨隧道封闭前交叉韧带重建移植物关节内愈合的影响. 中国矫形外科杂志, 2013, 21(18):1877-1881.
17.	Georgoulis AD, Pappa L, Moebius U, et al. The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc, 2001, 9(6):364-368.
18.	Sonnery-Cottet B, Lavoie F, Ogassawara R, et al. Clinical and operative characteristics of cyclops syndrome after double-bundle anterior cruciate ligament reconstruction. Arthroscopy, 2010, 26(11): 1483-1488.
19.	Wang J, Ao Y. Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy, 2009, 25(6):626-631.
20.	Kondo E, Yasuda K, Onodera J, et al. Effects of Remnant Tissue Preservation on Clinical and Arthroscopic Results After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction. Am J Sports Med, 2015, 43(8):1882-1892.
21.	Cha J, Choi SH, Kwon JW,et al. Analysis of cyclops lesions after different anterior cruciate ligament reconstructions:a comparison of the single-bundle and remnant bundle preservation techniques. Skeletal Radiol, 2012, 41(8):997-1002.

1. Janssen KW, Orchard JW, Driscoll TR, et al. High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003-2004 to 2007-2008:time for an anterior cruciate ligament register by Scandinavian model?. Scand J Med Sci Sports, 2012, 22(4):495-501.
2. Buller LT, Best MJ, Baraga MG, et al. Trends in Anterior Cruciate Ligament Reconstruction in the United States. Orthop J Sports Med, 2015, 3(1):2325967114563664.
3. 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.
4. Yasuda K, Kondo E, Kitamura N, et al. A pilot study of anatomic double-bundle anterior cruciate ligament reconstruction with ligament remnant tissue preservation. Arthroscopy, 2012, 28(3):343-353.
5. Demirag B, Ermutlu C, Aydemir F, et al. A comparison of clinical outcome of augmentation and standard reconstruction techniques for partial anterior cruciate ligament tears. Eklem Hastalik Cerrahisi, 2012, 23(3):140-144.
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 oneyear follow-up. J Bone Joint Surg Br, 2007, 89(9):1165-1171.
7. Hong L, Li X, Zhang H, et al. Anterior cruciate ligament reconstruction with remnant preservation:a prospective, randomized controlled study. Am J Sports Med, 2012, 40(12):2747-2755.
8. Pujol N, Colombet P, Potel JF, et al. Anterior cruciate ligament reconstruction in partial tear:selective anteromedial bundle reconstruction conserving the posterolateral remnant versus singlebundle anatomic ACL reconstruction:preliminary 1-year results of a prospective randomized study. Orthop Traumatol Surg Res, 2012, 98(8):171-177.
9. Zhang Q, Zhang S, Cao X, et al. The effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with hamstring autograft:A prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2014, 22(1):166-173.
10. Sabat D, Kundu K, Arora S, et al. Tunnel widening after anterior cruciate ligament reconstruction:a prospective randomized computed tomography——based study comparing 2 different femoral fixation methods for hamstring graft. Arthroscopy, 2011, 27(6):776-783.
11. Xu Y, Ao Y, Wang J, et al. Relation of tunnel enlargement and tunnel placement after single-bundle anterior cruciate ligament reconstruction. Arthroscopy, 2011, 27(7):923-932.
12. Zysk SP, Fraunberger P, Veihelmann A, et al. Tunnel enlargement and changes in synovial fluid cytokine profile following anterior cruciate ligament reconstruction with patellar tendon and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc, 2004, 12(2):98-103.
13. 孙磊, 吴波, 田敏, 等. 兔保留与切除残迹前交叉韧带重建生物力学的比较. 中华关节外科杂志, 2013, 7(1):81-85.
14. Weiler A, Peters G, Maurer J, et al. Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging. A two-year study in sheep. Am J Sports Med, 2001, 29(6):751-761.
15. Papalia R, Franceschi F, Vasta S, et al. Sparing the anterior cruciate ligament remnant:is it worth the hassle?. Br Med Bull, 2012, 104(1): 91-111.
16. 高加智, 孙磊. 保留残迹对骨隧道封闭前交叉韧带重建移植物关节内愈合的影响. 中国矫形外科杂志, 2013, 21(18):1877-1881.
17. Georgoulis AD, Pappa L, Moebius U, et al. The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc, 2001, 9(6):364-368.
18. Sonnery-Cottet B, Lavoie F, Ogassawara R, et al. Clinical and operative characteristics of cyclops syndrome after double-bundle anterior cruciate ligament reconstruction. Arthroscopy, 2010, 26(11): 1483-1488.
19. Wang J, Ao Y. Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy, 2009, 25(6):626-631.
20. Kondo E, Yasuda K, Onodera J, et al. Effects of Remnant Tissue Preservation on Clinical and Arthroscopic Results After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction. Am J Sports Med, 2015, 43(8):1882-1892.
21. Cha J, Choi SH, Kwon JW,et al. Analysis of cyclops lesions after different anterior cruciate ligament reconstructions:a comparison of the single-bundle and remnant bundle preservation techniques. Skeletal Radiol, 2012, 41(8):997-1002.

Chinese Journal of Evidence-Based Medicine

Efficacy of Remnant-preserving Anterior Cruciate Ligament Reconstruction versus Standard Anterior Cruciate Ligament Reconstruction by Arthroscopy: A Meta-analysis

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