An Arthroscopic Second-Look Study on the Effect of Remnant Preservation on Synovialization of Bone-Patellar Tendon-Bone Allograft in Anterior Cruciate Ligament Reconstruction.

Abstract

To assess the effects of preserved more anterior cruciate ligament (ACL) remnant on synovial coverage, knee stability, and function after bone patellar-tendon-bone (BPTB) allograft reconstruction through second-look arthroscopy and follow-up study. From June 2007 to February 2009, 51 patients received single bundle BPTB allograft ACL reconstruction and second arthroscopic examination. The patients were divided into 4 types according to the types of ACL remnant: type 1, 18 had bridging between the posterior cruciate ligament and the tibia; type 2, 21 had bridging between the intercondylar notch roof and the tibia; type 3, 4 had bridging between the lateral condyle and the tibia; and type 4, 8 subjects had no ACL remnants. Clinical results were evaluated with the KT-1000 maximum displacement test and Lysholm scale at mean 12.3- and 53.5-month follow-up. Second-look synovium coverage was recorded as follows: covering 25% or less, 25% to 50%, 50% to 75%, and more than 75%. Mean percentage of synovium coverage, Lysholm scale, and KT-1000 side-to-side difference were poorer in types 3 and 4 than the other 2 types at mean 12.3-month follow-up without statistical differences. The result of the final follow-up was comparable with the first one. Four patients had ruptured grafts and accepted revision surgery. Three of them belonged to types 3 and 4, and 1 patient with sport trauma belonged to type 2. There were other 11 patients with different types of impingement and partial absorption of grafts. Although lack of statistical power, follow-up study and second-look arthroscopy showed that preserved type 3 and 4 ACL remnant caused poorer synovium coverage and might lead to earlier failure when using BPTB allograft. Early minor laxity at 12.3-month follow-up seemed to be not progressive at the final follow-up. Level III, case-control study.