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A new remnant preservation technique reduces bone tunnel enlargement after anatomic double-bundle anterior cruciate ligament reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the effect of a new remnant preservation technique with a focus on remnant continuity on postoperative femoral and tibial tunnel enlargement after anatomical double-bundle anterior cruciate ligament reconstruction (ACLR).

Methods

A total of 150 knees were divided into three groups: Preservation Group (Group P: 49 knees), wherein the remnant continuity remained after tunnel creation; Resection Group (Group R: 47 knees), wherein the remaining remnant was resected, and Absent Group (Group A: 54 knees), wherein the remnant had no femoral attachment before tunnel creation. In Group P, the remnant maintained continuity, and the anteromedial (AM) and posterolateral (PL) bundles were positioned anterior and posterior to the remnant, respectively. Computed tomographic scans were performed at 1 week and 1 year after surgery, and the cross-sectional area of each tunnel aperture was measured. Tunnel enlargement was compared among the three groups by one-way analysis of variance (ANOVA) and the Bonferroni test. Univariate and multivariate logistic analyses were performed to identify the risk factors for tunnel enlargement in demographic and radiographic data.

Result

For femoral AM tunnels, the tunnel enlargement of Group P was significantly smaller than Groups R and A (p < 0.001), femoral PL (p < 0.001 vs. R and A), tibial AM (p < 0.001 vs. R, 0.002 vs. A), and tibial PL (p < 0.001 vs. R, 0.002 vs. A). There was no significant difference between Groups R and A. Multivariate logistic analysis showed that remnant preservation was a significant factor in reducing tunnel enlargement in the femoral AM, femoral PL, tibial AM, and tibial PL.

Conclusion

The new remnant-preserving anatomical double-bundle ACLR, which preserves the continuity of the remnant, prevented all bone tunnel enlargement at 1 year postoperatively.

Level of evidence

Level III.

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Acknowledgements

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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, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan

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

  2. Department of Rehabilitation, Shinshu University Hospital, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan

    Hiroshi Horiuchi

  3. Institute for Biomedical Sciences, Shinshu University School of Medicine, 3-26-1, Asahi, Matsumoto, Nagano, 390-8621, Japan

    Naoto Saito

Authors
  1. Suguru Koyama
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  2. Keiji Tensho
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Contributions

SK and KT were responsible for the design of the study. SK, HS, TI and DK were responsible for all recruitment and data collection procedures. SK, TI and DK participated in the data analysis and interpretation. SK and KT drafted the manuscript. KT, HH, NS 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 (April 12th, 2021/ No. 5109).

Informed consent

Informed consent was obtained in the form of an opt-out on the hospital website. The research subjects were given information on the study and guaranteed an opportunity to refuse to participate or to continue the study.

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Koyama, S., Tensho, K., Shimodaira, H. et al. A new remnant preservation technique reduces bone tunnel enlargement after anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 30, 2020–2028 (2022). https://doi.org/10.1007/s00167-022-06882-y

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