Anterior cruciate ligament reconstruction with remnant preservation: current concepts
Benjamin B. Rothrauff, Eiji Kondo, Rainer Siebold, Joon Ho Wang, Kyoung Ho Yoon, Freddie H. Fu
Abstract
Anterior cruciate ligament (ACL) reconstruction (ACLR) with remnant preservation presently includes selective bundle reconstruction of partial (one-bundle) ACL tears and single-and double-bundle ACLR with minimal to partial debridement of the torn ACL stump. Potential benefits of remnant preservation include accelerated graft revascularisation and remodelling, improved proprioception, decreased bone tunnel enlargement, individualised anatomic bone tunnel placement, improved objective knee stability and early mechanical support (with selective bundle reconstruction) to healing tissues. The literature does not support increased complications following ACLR with remnant preservation; there is no increase in the risk of cyclops formation, extension deficit or arthrofibrosis. Clinical studies of ACLR with remnant preservation are heterogeneous in the description of remnant characteristics and surgical technique. Based on the present literature, there is promising but insufficient evidence to support the superiority of ACLR with remnant preservation over the standard technique. It remains to be seen if and when remnant preservation should be applied in primary ACLR and future research is needed to refine indications and techniques. Future perspectives Future studies should better describe the ACL tear pattern, remnant volume, remnant quality and surgical technique. Studies of long-term outcomes after ACLR with remnant preservation are needed. Progress made on understanding and applying remnant preservation may inform, and be reciprocally guided by, ongoing research on ACL repair.