Effectiveness of a novel remnant-preserving anterior cruciate ligament reconstruction with bidirectional barbed suture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HE Qingsong , ZHUANG Leiting , AN Zihao , XU Wennan ,  ZHANG Hangzhou

Department of Sports Medicine and Joint Surgery/Orthopaedics, the First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China;

Corresponding author：

ZHANG Hangzhou, Email: zhanghz1000@sina.com

Keywords：

Anterior cruciate ligament reconstruction; remnant-preserving reconstruction; bidirectional barbed suture; Cyclops lesion

DOI：

10.7507/1002-1892.201809132

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Objective To investigate the feasibility and effectiveness of a novel remnant-preserving anterior cruciate ligament (ACL) reconstruction with bidirectional barbed suture.Methods Between February 2014 and January 2016, 96 patients (96 knees) with ACL injury who met the inclusion criteria were recruited and randomly divided into 2 groups (n=48). All patients underwent ACL reconstruction with autologous tendon. The tibial remnant was fixed with PDS-Ⅱ suture (control group) and bidirectional barbed suture (trial group). There was no significant difference in age, gender, injury side, the interval from injury to operation, and preoperative knee stability (KT-1000 test), International Knee Documentation Committee (IKDC) score, and Lysholm score (P>0.05). The knee stability (KT-1000 test), IKDC score, Lysholm score, proprioception, and Cyclops lesion after operation were recorded.Results All incisions healed by first intention in both groups. Forty-four patients in control group were followed up 26-47 months (mean, 36.6 months), and 45 patients in trial group were followed up 26-48 months (mean, 35.6 months). At last follow-up, the IKDC score, Lysholm score, and KT-1000 test were significantly improved when compared with preoperative ones in both groups (P<0.05); but no significant difference was found between 2 groups (P>0.05). There was no significant difference in proprioception between 2 groups at 1 and 2 years after operation, and between 1 year after operation and 2 years after operation (P>0.05) in the same group. The incidences of Cyclops lesion at 6 months, 1 year and 2 years after operation were 0, 4.44% (2/45), and 4.44% (2/45) in trial group, and 13.6% (6/44), 13.6% (6/44), 20.5% (9/44) in control group, showing significant differences between 2 groups at 6 months and at 2 years after operation (P=0.012; P=0.022) and no significant difference at 1 year after operation (P=0.157).Conclusion The remnant-preserving ACL reconstruction with bidirectional barbed suture can decrease the incidence of Cyclops lesions. However, this technique can not improve the effectiveness in terms of the clinical function and stability compared with the traditional technique.

Citation： HE Qingsong, ZHUANG Leiting, AN Zihao, XU Wennan, ZHANG Hangzhou. Effectiveness of a novel remnant-preserving anterior cruciate ligament reconstruction with bidirectional barbed suture. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(2): 149-153. doi: 10.7507/1002-1892.201809132 Copy

1.	李飞龙, 罗小辑, 梁熙, 等. 前交叉韧带解剖研究进展及其对韧带重建技术的影响. 中国修复重建外科杂志, 2018, 32(3): 377-381.
2.	吴冰, 丘志河, 李盛, 等. 自体腘绳肌腱移植重建前交叉韧带后移植物的组织学研究. 中国修复重建外科杂志, 2018, 32(7): 873-879.
3.	Adachi N, Ochi M, Uchio Y, et al. Anterior cruciate ligament augmentation under arthroscopy: a minimum 2-year follow-up in 40 patients. Arch Orthop Trauma Surg, 2000, 120(3-4): 128-133.
4.	Ochi M, Iwasa J, Uchino Y, et al. The regeneration of sensory neurones in the reconstruction of the anterior cruciate ligament. J Bone Joint Surg (Br), 1999, 81(5): 902-906.
5.	Ahn JH, Lee YS, Ha HC. Anterior cruciate ligament reconstruction with preservation of remnant bundle using hamstring autograft: technical note. Arch Orthop Trauma Surg, 2009, 129(8): 1011-1015.
6.	Ahn JH, Wang JH, Lee YS, et al. Anterior cruciate ligament reconstruction using remnant preservation and a femoral tensioning technique: clinical and magnetic resonance imaging results. Arthroscopy, 2011, 27(8): 1079-1089.
7.	Aydoğ ST, Korkusuz P, Doral MN, et al. Decrease in the numbers of mechanoreceptors in rabbit ACL: the effects of ageing. Knee Surg Sports Traumatol Arthrosc, 2006, 14(4): 325-329.
8.	Georgoulis AD, Pappa L, Moebius U, et al. The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc, 2001, 9(6): 364-368.
9.	Lee BI, Min KD, Choi HS, et al. Immunohistochemical study of mechanoreceptors in the tibial remnant of the ruptured anterior cruciate ligament in human knees. Knee Surg Sports Traumatol Arthrosc, 2009, 17(9): 1095-1101.
10.	Muellner T, Kdolsky R, Grossschmidt K, et al. Cyclops and cyclopoid formation after, anterior cruciate ligament reconstruction: clinical and histomorphological differences. Knee Surgery Sports Traumatology Arthroscopy, 1999, 7(5): 284-289.
11.	Tie K, Chen L, Hu D, et al. The difference in clinical outcome of single-bundle anterior cruciate ligament reconstructions with and without remnant preservation: A meta-analysis. Knee, 2016, 23(4): 566-574.
12.	Hu J, Qu J, Xu D, et al. Clinical outcomes of remnant preserving augmentation in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2014, 22(9): 1976-1985.
13.	Papalia R, Franceschi F, Vasta S, et al. Sparing the anterior cruciate ligament remnant: is it worth the hassle? Br Med Bull, 2012, 104: 91-111.
14.	Junkin DM, Johnson DL. ACL tibial remnant, to save or not. Orthopedics, 2008, 31(2): 154-159.
15.	Cha J, Choi SH, Kwon JW, et al. Analysis of cyclops lesions after different anterior cruciate ligament reconstructions: a comparison of the single-bundle and remnant bundle preservation techniques. Skeletal Radiol, 2012, 41(8): 997-1002.

1. 李飞龙, 罗小辑, 梁熙, 等. 前交叉韧带解剖研究进展及其对韧带重建技术的影响. 中国修复重建外科杂志, 2018, 32(3): 377-381.
2. 吴冰, 丘志河, 李盛, 等. 自体腘绳肌腱移植重建前交叉韧带后移植物的组织学研究. 中国修复重建外科杂志, 2018, 32(7): 873-879.
3. Adachi N, Ochi M, Uchio Y, et al. Anterior cruciate ligament augmentation under arthroscopy: a minimum 2-year follow-up in 40 patients. Arch Orthop Trauma Surg, 2000, 120(3-4): 128-133.
4. Ochi M, Iwasa J, Uchino Y, et al. The regeneration of sensory neurones in the reconstruction of the anterior cruciate ligament. J Bone Joint Surg (Br), 1999, 81(5): 902-906.
5. Ahn JH, Lee YS, Ha HC. Anterior cruciate ligament reconstruction with preservation of remnant bundle using hamstring autograft: technical note. Arch Orthop Trauma Surg, 2009, 129(8): 1011-1015.
6. Ahn JH, Wang JH, Lee YS, et al. Anterior cruciate ligament reconstruction using remnant preservation and a femoral tensioning technique: clinical and magnetic resonance imaging results. Arthroscopy, 2011, 27(8): 1079-1089.
7. Aydoğ ST, Korkusuz P, Doral MN, et al. Decrease in the numbers of mechanoreceptors in rabbit ACL: the effects of ageing. Knee Surg Sports Traumatol Arthrosc, 2006, 14(4): 325-329.
8. Georgoulis AD, Pappa L, Moebius U, et al. The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc, 2001, 9(6): 364-368.
9. Lee BI, Min KD, Choi HS, et al. Immunohistochemical study of mechanoreceptors in the tibial remnant of the ruptured anterior cruciate ligament in human knees. Knee Surg Sports Traumatol Arthrosc, 2009, 17(9): 1095-1101.
10. Muellner T, Kdolsky R, Grossschmidt K, et al. Cyclops and cyclopoid formation after, anterior cruciate ligament reconstruction: clinical and histomorphological differences. Knee Surgery Sports Traumatology Arthroscopy, 1999, 7(5): 284-289.
11. Tie K, Chen L, Hu D, et al. The difference in clinical outcome of single-bundle anterior cruciate ligament reconstructions with and without remnant preservation: A meta-analysis. Knee, 2016, 23(4): 566-574.
12. Hu J, Qu J, Xu D, et al. Clinical outcomes of remnant preserving augmentation in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2014, 22(9): 1976-1985.
13. Papalia R, Franceschi F, Vasta S, et al. Sparing the anterior cruciate ligament remnant: is it worth the hassle? Br Med Bull, 2012, 104: 91-111.
14. Junkin DM, Johnson DL. ACL tibial remnant, to save or not. Orthopedics, 2008, 31(2): 154-159.
15. Cha J, Choi SH, Kwon JW, et al. Analysis of cyclops lesions after different anterior cruciate ligament reconstructions: a comparison of the single-bundle and remnant bundle preservation techniques. Skeletal Radiol, 2012, 41(8): 997-1002.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of a novel remnant-preserving anterior cruciate ligament reconstruction with bidirectional barbed suture

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