title: Sparing the anterior cruciate ligament remnant: is it worth the hassle?
abstract: BACKGROUND
  Anterior cruciate ligament (ACL) rupture is the most common surgically treated ligament injury. Many efforts have been taken to reconstruct it as anatomically as possible to restore knee stability and, possibly, prevent knee osteoarthritis.
  
  
  METHODS
  A literature search was performed using the isolated or combined keywords 'ACL augmentation remnant', 'ACL reconstruction and remnant and stump', 'ACL reconstruction and remnant and stump preserving and stability' and 'ACL remnant complete tear' with no limit regarding the year of publication. We identified seven published studies.
  
  
  RESULTS
  The ACL remnant might accelerate the vascularization and the ligamentization of the graft and contribute to faster graft innervation leading to a better proprioception.
  
  
  RESULTS
  The role of the ACL remnant is debated, because, although it may increase the risk of impingement and the formation of cyclops lesion, its preservation can improve proprioception, biomechanical functions and vascularity. However, the current assessment methods to assess proprioception, vascularization and the ligamentization do not lead to hard evidence that preservation of the remnant confers clinically relevant advantages over its excision.
  
  
  CONCLUSIONS
  The ACL remnant has been demonstrated in experimental studies to have a role in improving revascularization, ligamentization and reinnervation of the graft, but these findings are still not supported by clinical findings. A more direct way to assess proprioceptive function after ACL reconstruction and appropriately conducted powered and rigorously prospective randomized double-blind studies comparing the clinical outcomes of excising the remnant to leaving it in situ are necessary.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
authors.forename: Francesco
authors.initials: F
authors.lastname: Franceschi
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Vasta
authors.forename: Alberto
authors.initials: A
authors.lastname: Di Martino
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D020370:Osteoarthritis, Knee / Q000517:prevention & control; D011434:Proprioception; D016896:Treatment Outcome