Does the tibial remnant of the anterior cruciate ligament promote ligamentization?
BACKGROUND
The purpose of this study was to clarify the difference in ligamentization between the remnant-preserving (RP) and remnant-sacrificing (RS) techniques in anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI).


METHODS
A retrospective comparative study was carried out on 98 patients undergoing ACL reconstruction using either an RP (n=56) or RS (n=42) technique. MRI was performed at one of four time points postoperatively, and the signal intensity of the ACL graft was analyzed using the signal to noise quotient (SNQ) ratio and inter-bundle high signal intensity, along with an analysis of the survival rate of remnant tissue.


RESULTS
The mean SNQ ratio of grafted tendons in the RP group was significantly higher than that seen in the RS group in the proximal and middle regions two to four months after surgery (P<0.05) and was significantly lower than that seen in the RS group in all regions at 12 -18months (P<0.05). The inter-bundle high signal intensity was observed more frequently in the RP group (73.7%) at two to four months. Tibial remnants were observed on postoperative MRI regardless of when MRI was conducted.


CONCLUSIONS
The ACL graft of the RP group showed higher signal intensity in the early stage and lower signal intensity in the late stage compared to that of the RS group. The ligamentization of grafts in the RP group proceeded more quickly. Preserving the remnant in ACL reconstruction appears to have a positive effect on ligamentization.
Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea.
Byung Ill
BI
Lee
Department of Orthopedic Surgery, College of Medicine, Konkuk University, Chungcheongbuk-do, Republic of Korea. Electronic address: stompower@hanmail.net.
Byoung Min
BM
Kim
Department of Orthopedic Surgery, College of Medicine, Konkuk University, Chungcheongbuk-do, Republic of Korea.
Duk Hwan
DH
Kho
Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea.
Sai Won
SW
Kwon
Department of Orthopedic Surgery, College of Medicine, Konkuk University, Chungcheongbuk-do, Republic of Korea.
Hyeung June
HJ
Kim
Department of Orthopedic Surgery, College of Medicine, Konkuk University, Chungcheongbuk-do, Republic of Korea.
Hyun Ryong
HR
Hwang
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000473:pathology*; D000070598:Anterior Cruciate Ligament Injuries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D000070632:Hamstring Tendons / Q000637:transplantation*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059351:Organ Sparing Treatments / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
ACL reconstruction; Anterior cruciate ligament; Knee; Ligamentization; Magnetic resonance imaging; Remnant-preserving technique