title: 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.
authors.affiliation: Center of Joint Surgery, Southwest Hospital, Chongqing, People's Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: Guo
authors.affiliation: Center of Joint Surgery, Southwest Hospital, Chongqing, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.affiliation: Center of Joint Surgery, Southwest Hospital, Chongqing, People's Republic of China.
authors.forename: Jiang-Ming
authors.initials: JM
authors.lastname: Luo
authors.affiliation: Center of Joint Surgery, Southwest Hospital, Chongqing, People's Republic of China. Electronic address: jointsurgery@163.com.
authors.forename: Liu
authors.initials: L
authors.lastname: Yang
authors.affiliation: Center of Joint Surgery, Southwest Hospital, Chongqing, People's Republic of China.
authors.forename: Ling-Chuan
authors.initials: LC
authors.lastname: Gu
authors.affiliation: Center of Joint Surgery, Southwest Hospital, Chongqing, People's Republic of China.
authors.forename: De-Jie
authors.initials: DJ
authors.lastname: Fu
mesh_terms: D000328:Adult; D064591:Allografts; D016118:Anterior Cruciate Ligament / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D001842:Bone and Bones / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D017847:Patellar Ligament / Q000637:transplantation*; D016119:Posterior Cruciate Ligament / Q000601:surgery; D012086:Reoperation; D012421:Rupture / Q000601:surgery; D024162:Second-Look Surgery / Q000379:methods*; D013583:Synovial Membrane; D013977:Tibia / Q000601:surgery; D014184:Transplantation, Homologous; D014945:Wound Healing; D055815:Young Adult