Summary

we found no difference in terms of anterior fibrosis, extension deficit, subjective scores, return to sports and failure rates. We believe there is an important role for tissue preservation

Abstract

Introduction

In the past decade, several authors discussed the presence of mechanoreceptors and vascularization of the Anterior Cruciate Ligament (ACL). As a result of this concept, an attempt is made to preserve as much tissue as possible in ACL surgery. But, potential complications such as extension deficit, anterior fibrosis (cyclops) and the bad location of the tunnels have been described.
The objective of our work was to evaluate a series of patients treated for an ACL-R with different tissue preservation techniques and compare it with the standard technique.

Materials And Methods

We included patients operated between 2015 and 2019 for ACL-R with a minimum follow-up of 2 years. According to the preservation technique, we divided the series into 5 groups. Group A: less than 50% distal remnant; Group B: threaded inside the ACL; Group C: preserves a complete band; Group D: re-tensioning of remaining fibers; Group E: control group, no fiber preservation. We included those with autologous hamstring technique and minimum follow-up of 2 years. All patients complied with the same postoperative rehabilitation protocol. Clinical examination, the time of return to sport and subjective Lysholm and IKDC scores and failure rates were recorded. The presence of cyclops (anterior fibrosis) was evaluated with magnetic resonance (MR).

Results

We included 250 patients; 63 from Group A, 14 from Group B, 92 from Group C, 38 from Group D and 42 from Group E. The mean follow up was 38.7 months (SD 9.9), 42 months (SD 8.6) in group A, 25.5 months (SD 1.4) in group B, 39.4 months (SD 8.8) in group C, 31.2 months (SD 3.1) in group D and 42.6 (SD 12.8) in group E.
Two patients, both from group A, presented loss of 3° and 5° of extension at last follow-up.
Mean return to sports time was 9.1 months (SD 3.1) in group A, 9.1 months (SD 1.6) in group B, 8.9 months (SD 2.9) in group C, 8.8 months (SD 1.5) in group D and 9.2 months (SD 3.4) in group E. Seven (11%) patients in group A, 0 in group B, 3 (3%) in group C, 4 (11%) in group D and 2 (5%) in group E decreased the Tegner score. No differences were found for Lysholm and IKDC scores between groups. 30% of the population underwent MRI.
In 16 patients cyclops was observed on MRI. Eleven were asymptomatic. Five required a second surgical procedure for anterior fibrosis resection: 2 from group A, 2 from group C and 2 from group E. Four patients presented ACL failure that required revision surgery, 2 in group A and 2 in group C.

Conclusion

The most important finding of this work is that we found no difference in terms of anterior fibrosis, extension deficit, subjective scores, return to sports and failure rates. We believe there is an important role for tissue preservation.