The Effect of a Tibial Remnant Preservation Technique on the Synovialization of the Graft Tendon in Anterior Cruciate Ligament Reconstruction: Based on the Second Look Arthroscopic Findings

Ahn, Gil Yeong; Nam, Il Hyun; Moon, Gi Hyuk; Lee, Yeong Hyun; Choi, Seong Pil; Yoo, Jong Yeon

Abstract

PURPOSE
The purpose of this study is to evaluate the effect of preservation of the tibial remnant on the synovialization of graft tendon after the reconstruction of anterior cruciate ligament (ACL) based on the second look arthroscopic findings.
MATERIALS AND METHODS
From May 2005 to May 2012, among sixty three patients having ACL reconstruction with the four-strand hamstring using a bioabsorbable cross pin (RigidFix(R)) for the femoral tunnel, nineteen patients who had second look arthroscopy were analyzed. We classified them into three groups according to the tibial remnant of the torn ACL for arthroscopic findings. Group 1 had less than 5 mm of a remnant tissue, Group 2 had from 6 mm to 10 mm of it, and Group 3 had more than 11 mm. We estimated the percentage of synovial coverage on the graft tendon during second look arthroscopy. We evaluated Lysholm score and Tegner activity score preoperatively and in the last follow-up.
RESULTS
At the time of ACL reconstruction, the mean length of preserved tibial remnant of torn ACL was 2.3 mm in Group 1, 7.4 mm in Group 2, and 13.7 mm in Group 3. In the second look arthroscopy, the average percentage of synovial coverage was 55.4% in Group 1, and 77.9% in Group 2, and 89.7% in Group 3. Lysholm score and Tegner activity score improved from 74.2 and 7.3 preoperatively to 94.1 and 8.5 in the last follow-up.
CONCLUSION
The preservation of tibial remnant of torn ACL influenced the synovial coverage of the graft tendon and the volume of preserved remnant in accordance with the surface of synovial coverage. It would have a good effect on graft healing and preservation of proprioceptive function.