Purpose
Our purpose was (1) to compare the structural integrity and healing capacity of the
acutely repaired anterior cruciate ligament (ACL) remnants and (2) to determine whether
the short-term postoperative biomechanical results of the acute remnant-repairing
anterior cruciate ligament reconstruction (ACLR) were superior to the conventional
ACLR.
Methods
An acute complete ACL femoral detachment model was created in 50 rabbits. The rabbits
were immediately randomly allocated into the remnant-repairing ACLR group (group 1,
n = 25) and the conventional ACLR group (group 2, n = 25). Each animal in both groups
was subjected to unilateral ACLR with semitendinosus tendon autografts. During ACLR,
the ACL remnants were acutely repaired with the femoral-tensioning technique in group
1, whereas the ACL remnants were debrided in group 2. The outcomes of the remnant
were macroscopically evaluated in group 1. The remnant's structural integrity and
remnant-to-graft healing capacity were divided into 3 categories (grade A, good; grade
B, fair; or grade C, poor) according to 2 distinct criteria. Biomechanical tests including
the anterior tibial translation test at 30° and 90° of knee flexion and tensile tests
were compared between groups. All the macroscopic evaluations and biomechanical tests
were performed postoperatively at week 12.
Results
The macroscopic evaluations of the ACL remnants in group 1 (n = 25) showed that the
remnants' structural integrity was grade A (well-maintained continuity with an adequate
amount of tissue and tension on probing) in 10 specimens (40%), grade B (fairly maintained
continuity with thin and slack fibers detected) in 5 (20%), and grade C (resorption
with no remnant left in situ) in 10 (40%). The remnant-to-graft healing capacities
among the specimens with surviving remnants (grades A and B for structural integrity,
n = 15) were all classified as grade C (an obvious remnant-to-graft interval through
the entire length of the graft). For the biomechanical tests, there were no significant
differences between the groups (25 in each group) with respect to the anterior tibial
translation test at 30° (P = .15) and 90° (P = .91) of knee flexion and stiffness (P = .66), ultimate failure load (P = .11), and elongation at failure (P = .92).
Conclusions
In our rabbit model of ACL femoral detachment, the acutely repaired ACL remnants showed
a high resorption rate, low healing capacity, and poor biomechanical properties. The
acute remnant-repairing ACLR had no evident superiority over the conventional ACLR
in rabbits.
Clinical Relevance
The findings did not support the contention that the remnant-repairing ACLR, even
performed in the acute setting, could produce better postoperative knee joint stability
outcomes than the conventional ACLR.
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Article info
Publication history
Accepted:
November 26,
2013
Received:
July 6,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: G-Y.S. and H.F. receive support from National Natural Science Foundation of China (81071485).
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
