The role of remnant preservation and augmentation in the improvement of clinical outcome following anterior cruciate ligament reconstruction is a subject of significant debate. Published studies have several limitations including a limited number of patients and control groups for direct comparison of outcomes. Although concerns continue to exist with respect to an increased risk of impingement following augmentation, the clinical outcomes of remnant preserving surgery are promising. In particular improvement in proprioception has been reported. However, a more direct way to assess proprioceptive function, graft remodelling and appropriately powered prospective randomised double-blind studies is required to produce hard evidence that preservation of the remnant confers clinically relevant advantages over its excision.
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