Combined Anterior Cruciate Ligament Tensioned Remnant Suspension Repair and Autograft Reconstruction for Sherman I-II Anterior Cruciate Ligament Injuries.

Abstract

Arthroscopic anterior cruciate ligament reconstruction with tensioned remnant preservation is a simple, reproducible strategy designed to enhance graft biology and stability in appropriately selected patients while maintaining anatomic tunnel accuracy. Prioritized for acute cases with functional remnants (Sherman I-II), the approach leverages the remnant's "biologic scaffold" and "fluid-seal" effects to promote graft synovialization, revascularization, and reinnervation, reduce synovial fluid washout into the tunnels, and potentially improve rotational control. When applied under strict indications, this remnant-preserving, tensioning strategy can achieve functional outcomes comparable to standard anterior cruciate ligament reconstruction while providing additional benefits for graft integration and joint stability.