2015 ISAKOS Biennial Congress ePoster #1353

Effects of Remnant Tissue Preservation on Tendon Healing in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction using Magnetic Resonance Imaging

Jun Onodera, MD, PhD, Sapporo, Hokkaido JAPAN
Eiji Kondo, MD, PhD, Sapporo, Hokkaido JAPAN
Nobuto Kitamura, MD, PhD, Sapporo, Hokkaido JAPAN
Keita Sakamoto, MD, Sapporo, Hokkaido JAPAN
Hiroyuki Sugimori, RT, PhD, Sapporo, Hokkaido JAPAN
Norimasa Iwasaki, MD, PhD, Sapporo, Hokkaido JAPAN
Kazunori Yasuda, MD, PhD, Prof., Sapporo, Hokkaido JAPAN

Department of Sports Medicine and Joint Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, JAPAN

FDA Status Cleared

Summary: This study demonstrated that the high intensity change of the femoral tunnel of the posterolateral bundle graft in anatomic double-bundle ACL reconstruction with remnant preservation was significantly less than that in conventional double-bundle reconstruction without remnant preservation.

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Abstract:

Introduction

To verify whether preservation of the ACL remnant tissue can actually improve the tendon healing, we should conduct a randomized comparative trial to compare the ACL reconstruction with and without the remnant preservation [1]. The purpose of this study was to examine biologic healing of the tendon autograft after double-bundle ACL reconstruction with remnant tissue preservation.

Methods

A prospective, comparative study was conducted with 41 patients who underwent anatomic double-bundle ACL reconstruction using hamstring autograft between 2010 and 2013.There were 21 men and 20 women with a mean age of 28 years (14–58 years) at the time of surgery. All patients were divided into 2 groups based on the remnant tissue type according to Crain’s classification. In Group I, anatomic double-bundle ACL reconstruction with remnant tissue preservation was performed with 31 patients. In Group II, conventional double-bundle reconstruction without remnant preservation was performed with 10 patients. At one year after surgery, all the patients were evaluated clinical outcome and 1.5-Tesla MRI (Philips). T2-weighted images were used for analysis. Using multi-planar reconstruction, the oblique sagittal images of the midsubstance of the anteromedial (AM) bundle graft, or posterolateral (PL) bundle graft were selected for analysis. In each slice, the native patella tendon (PT) was description in the same slice. Using the region-of-interest (ROI) function, the AM and PL bundles grafts, and the PT were outlined. Mean signal intensity of ROIs was recorded as absolute signal intensity [2]. Signal intensity ratio was calculated based on signal intensity of the PT. In addition, the interface between the graft and the femoral or tibial tunnel wall was graded in each T2WI was graded as high, or low signal intensity using the sagittal and coronal images. Statistical analyses were performed using Student’s t test.

Results

(1) The post-operative anterior laxity was 1.3 +/- 2.3 mm, and 1.6 +/- 2.1 mm in Groups I, and II, respectively. Concerning the Lysholm score, the IKDC evaluation, and the peak muscle torque of quadriceps and hamstrings, there were no significant differences among the 2 groups.
(2) Signal intensity ratio of the PL graft was higher than that of the AM graft in both groups. The signal intensity ratio of the AM and PL graft was lower in Group I than in Group II. However, there were no significant differences between the groups.
(3) Regarding bone-tendon healing, the high intensity change of the PL femoral tunnel in Group I was significantly less than that in Group II (p=0.045). There was no significant difference in the high intensity change of AM tunnel between the 2 groups. There were no correlations between high intensity change and the clinical results after surgery.

Discussion And Conclusion

This study demonstrated that the high intensity change of PL femoral tunnel in remnant preservation was significantly less than that in non- preservation. This result suggested that preservation of the remnant tissue may improve bone-tendon healing after double-bundle ACL reconstruction.
References: [1] Yasuda et al. Arthroscopy 2012 [2] Miyawaki et al. KSSTA 2014