Purpose
The role of the anterior cruciate ligament remnant in anterior cruciate ligament reconstruction
(ACLR) is debated. The purposes of this systematic review were (1) to summarize the
clinical outcomes of patients undergoing remnant-preserving ACLR and (2) to investigate
whether those outcomes were superior to standard ACLR.
Methods
The PubMed database was searched using specific inclusion and exclusion criteria for
clinical studies reporting both preoperative conditions and postoperative outcomes
of remnant-preserving ACLR. All reported postoperative complications were analyzed.
In addition, a modified Coleman Methodology Score (CMS) system was used to assess
the methodologic quality of the included studies.
Results
Thirteen studies were included with a mean CMS value of 71.7 (range, 57 to 92). In
total, 546 patients underwent remnant-preserving ACLR by 3 different procedures: standard
ACLR plus tibial remnant tensioning (n = 166), selective-bundle augmentation (n =
337), and standard ACLR plus tibial remnant sparing (n = 43). All clinical outcomes
improved significantly (P < .05) at the final follow-up (mean, 27.9 months). Seven studies directly compared
postoperative clinical outcomes between remnant-preserving ACLR and standard ACLR.
In 6 of the 7 studies, similar postoperative clinical outcomes were reported between
groups. One study reported superior clinical outcomes after remnant-preserving ACLR.
There was no significant difference between groups regarding the overall rate of postoperative
complications.
Conclusions
The mean CMS showed moderate methodologic quality for the included studies. This systematic
review showed significant postoperative improvements in patients undergoing remnant-preserving
ACLR in all of the studies. However, further comparisons between remnant-preserving
ACLR and standard ACLR showed inconsistent results in the 7 comparative studies, with
6 reporting equivalent postoperative clinical outcomes between groups. There was no
significant difference in the rate of total complications between groups. The currently
available evidence is not sufficiently strong to support the superiority of remnant-preserving
ACLR.
Level of Evidence
Level IV, systematic review of Level I-IV studies.
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Article info
Publication history
Published online: May 28, 2013
Accepted:
March 14,
2013
Received:
March 5,
2013
Footnotes
The authors report the following source of funding in relation to this article: National Natural Science Foundation of China (81071485).
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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- The Anterior Cruciate Ligament Remnant: To Leave It or Not?ArthroscopyVol. 29Issue 11
