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The effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with hamstring autograft: a prospective randomized controlled trial

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the effect of remnant preservation on tibial tunnel enlargement in a single-bundle anterior cruciate ligament (ACL) reconstruction with a hamstring autograft.

Methods

From 2006 to 2009, a total of 62 patients who underwent single-bundle ACL reconstruction with a quadrupled hamstring tendon autograft were enrolled in this study. The patients were randomly divided into two groups: the preserving-remnant group and the removing-remnant group. Plain radiographs were taken at 1 week, and 3, 6, and 24 months postoperatively, and tibial tunnel enlargement was evaluated. The postoperative clinical assessment included the Lysholm rating scale and KT-1000 measurement.

Results

In total, 27 patients in the preserving-remnant group and 24 patients in the removing-remnant group were followed up and the median follow-up was 24.5 months (range 24–27 months). Tibial tunnel enlargement occurred within 6 months postoperatively. Positive enlargement was observed in 8 patients (29.6 %) in the preserving-remnant group and 14 patients (58.3 %) in the removing-remnant group (P = 0.0388). The percentage of tibial tunnel enlargement was 25.7 ± 6.7 and 34.0 ± 8.9 % in the preserving- and removing-remnant groups, respectively (P = 0.0004). In the preserving-remnant group, the average Lysholm score increased from 60.3 ± 5.3 (51–69) to 93.0 ± 3.5 (88–100), and the side-to-side difference of the KT-1000 changed from 6.3 ± 0.9 (5.1–8.0) to 1.4 ± 0.6 (0.5–2.4) mm. In the removing-remnant group, the average Lysholm score increased from 58.7 ± 6.5 (48–71) to 91.1 ± 3.9 (85–100), and the side-to-side difference of the KT-1000 changed from 6.5 ± 0.8 (5.4–8.2) to 1.7 ± 0.6 (0.6–2.8) mm.

Conclusions

It is confirmed that remnant preservation in ACL reconstruction can resist tibial tunnel enlargement but that this technique does not affect the short-term clinical outcome of ACL reconstruction.

Level of evidence

I.

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Acknowledgments

The authors thank S. Kelly and L. Christina (American Journal Experts) for editing the present paper.

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthapaedic Surgery, The General Hospital of the Jinan Military Command, No. 25, Shifan Road, Jinan, Shandong, China

    Qiang Zhang, Shu Zhang, Xuecheng Cao, Lifeng Liu, Ya Liu & Rui Li

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  1. Qiang Zhang
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  2. Shu Zhang
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  3. Xuecheng Cao
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  5. Ya Liu
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Correspondence to Xuecheng Cao.

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Zhang, Q., Zhang, S., Cao, X. et al. The effect of remnant preservation on tibial tunnel enlargement in ACL reconstruction with hamstring autograft: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 22, 166–173 (2014). https://doi.org/10.1007/s00167-012-2341-7

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  • DOI: https://doi.org/10.1007/s00167-012-2341-7

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