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Remnant preserving augmentation using an adjunct anterolateral portal in anterior cruciate ligament reconstruction
Arthrosc Orthop Sports Med 2017;4:85-89
Published online July 1, 2017;  https://doi.org/10.14517/aosm17003
© 2017 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Su-Keon Lee, Beom-Seok Lee, Chae-Chul Lee, Chang Yk Lee

Department of Orthopedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
Correspondence to: Chang Yk Lee,
Department of Orthopedic Surgery, Gwangmyeong Sungae Hospital, 36 Digital-ro, Gwangmyeong 14241, Korea.
Tel: +82-2-2680-7114, Fax: +82-2-2680-7557, E-mail: czar245@naver.com
Received February 10, 2017; Revised May 29, 2017; Accepted June 12, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Anterior cruciate ligament (ACL) tears are rarely found without remnant tissue. Remnant tissue is usually found either attached to the posterior cruciate ligament (PCL) or bridging the femoral and tibial footprints. Keeping the remnant tissue intact during ACL reconstruction has been favored because it has been thought to promote revascularization of the graft and recovery of joint position sense. However, in our experience, we found that using the remnant preserving technique for ACL reconstruction led to unexpected complications such as blockage of the arthroscopic view by the remnant tissue itself and separation of the remnant tissue during tunnel formation. To overcome these complications associated with the remnant-preserving technique, we developed a novel technique using an adjunct anterolateral portal and a polydioxanone suture to stabilize remnant ACL tissue in place.
Keywords : Knee; Arthroscopes; Remnant preserving; Anterior cruciate ligament reconstruction
References
  1. Chen CH. Graft healing in anterior cruciate ligament reconstruction. Sports Med Arthrosc Rehabil Ther Technol 2009;1:21.
    CrossRef
  2. Adachi N, Ochi M, Uchio Y, Iwasa J, Ryoke K, Kuriwaka M. Mechanoreceptors in the anterior cruciate ligament contribute to the joint position sense. Acta Orthop Scand 2002;73:330-4.
    Pubmed CrossRef
  3. Schultz RA, Miller DC, Kerr CS, Micheli L. Mechanoreceptors in human cruciate ligaments. A histological study. J Bone Joint Surg Am 1984;66:1072-6.
    Pubmed CrossRef
  4. 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;9:364-8.
    Pubmed CrossRef
  5. Takahashi T, Kondo E, Yasuda K, et al. Effects of remnant tissue preservation on the tendon graft in anterior cruciate ligament reconstruction: a biomechanical and histological study. Am J Sports Med 2016;44:1708-16.
    Pubmed CrossRef
  6. Arnoczky SP, Tarvin GB, Marshall JL. Anterior cruciate ligament replacement using patellar tendon. An evaluation of graft revascularization in the dog. J Bone Joint Surg Am 1982;64:217-24.
    Pubmed CrossRef
  7. Ahn JH, Lee YS, Ha HC. Anterior cruciate ligament reconstruction with preservation of remnant bundle using hamstring autograft:technical note. Arch Orthop Trauma Surg 2009;129:1011-5.
    Pubmed CrossRef
  8. Adachi N, Ochi M, Uchio Y, Sumen Y. Anterior cruciate ligament augmentation under arthroscopy. A minimum 2-year follow-up in 40 patients. Arch Orthop Trauma Surg 2000;120:128-33.
    Pubmed CrossRef
  9. Lee BI, Kwon SW, Kim JB, Choi HS, Min KD. Comparison of clinical results according to amount of preserved remnant in arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft. Arthroscopy 2008;24:560-8.
    Pubmed CrossRef
  10. Sherman MF, Lieber L, Bonamo JR, Podesta L, Reiter I. The longterm followup of primary anterior cruciate ligament repair. Defining a rationale for augmentation. Am J Sports Med 1991;19:24355.
    Pubmed CrossRef