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Effect of a new remnant-preserving technique with anatomical double-bundle anterior cruciate ligament reconstruction on MRI-based graft maturity: a comparison cohort study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the effects of a new remnant-preserving double-bundle anterior cruciate ligament reconstruction (ACLR) technique, focused on avoiding remnant damage and preserving continuity of remnants, on graft maturity using magnetic resonance imaging (MRI).

Methods

A total of 169 patients were divided into three groups: 41 in the preservation group, 70 in the resection group, and 58 in the absent group. In the preservation group, rather than passing the graft through the remnant tissue, the graft was reconstructed such that the anteromedial and posterolateral bundles sandwiched the remnant to avoid damage to the remnant and maintain its continuity. Based on 1-year postoperative MRI, the grafts were divided into three regions: distal, middle, and proximal. The signal/noise quotient (SNQ) of each region of interest was calculated to evaluate the signal intensity of the graft and was compared among the three groups. Additionally, to identify factors influencing graft maturity, a multiple regression analysis was performed with SNQ as the dependent variable and patient demographics, bone morphology, and surgical factors as independent variables.

Results

In a three-group comparison of mean SNQs, the distal region was 3.3 ± 3.4, 8.9 ± 8.3, and 9.0 ± 8.6 (p < 0.001), the middle region was 5.3 ± 3.7, 10.9 ± 11.1, and 11.3 ± 10.2 (p < 0.001), and the proximal region was 6.8 ± 4.5, 11.1 ± 8.8, and 11.7 ± 10.8 (p = 0.017), in order of the preservation, resection, and absent groups, respectively. That indicated that the remnant-preserving ACLR was more hypointense than ACLR with remnant resection or absent in all three regions. Multiple regression analysis showed that remnant preservation remained the relevant factor affecting SNQ of the graft at the distal and middle levels.

Conclusion

The new remnant-preserving anatomic double-bundle ACLR had significantly better graft maturity, measured by SNQ on MRI, than the remnant resection and absent groups. The remnant procedure was the relevant factor affecting graft maturity.

Level of evidence

Level III.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan

    Hiroki Shimodaira, Keiji Tensho, Suguru Koyama, Tomoya Iwaasa, Daiki Kumaki, Kazushige Yoshida & Jun Takahashi

  2. Department of Rehabilitation, Shinshu University Hospital, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan

    Hiroshi Horiuchi

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  1. Hiroki Shimodaira
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Contributions

HS and KT were responsible for the design of the study. HS, SK, TI, DK and KY were responsible for all recruitment and data collection procedures. HS, TI and DK participated in the data analysis and interpretation. HS and KT drafted the manuscript. KT, HH, KY and JT revised and approved the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Keiji Tensho.

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Conflict of interest

The author(s) declare that they have no competing interests.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Shinshu University.

Informed consent

The documentation of informed consent was waived by the Institutional Review Board because of the retrospective nature of the study and the analysis used anonymous clinical data. We disclosed the information on conducting the study to the research subjects, guaranteed an opportunity to refuse to conduct or continue the study.

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Shimodaira, H., Tensho, K., Koyama, S. et al. Effect of a new remnant-preserving technique with anatomical double-bundle anterior cruciate ligament reconstruction on MRI-based graft maturity: a comparison cohort study. Knee Surg Sports Traumatol Arthrosc 31, 2394–2405 (2023). https://doi.org/10.1007/s00167-022-07180-3

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