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  • Title: Preservation of remnant with poor synovial coverage has no beneficial effect over remnant sacrifice in anterior cruciate ligament reconstruction.
    Author: Kim BH, Kim JI, Lee O, Lee KW, Lee MC, Han HS.
    Journal: Knee Surg Sports Traumatol Arthrosc; 2018 Aug; 26(8):2345-2352. PubMed ID: 28822999.
    Abstract:
    PURPOSE: The purpose of the study was to evaluate the influence of synovial coverage of the remnant on clinical outcomes and graft healing in anterior cruciate ligament (ACL) reconstruction. METHODS: Seventy-five patients who underwent second-look arthroscopy after a single-bundle ACL reconstruction using autologous quadriceps tendon graft were included. The patients were divided into two groups according to whether the remnant was preserved (group P, n = 42) or sacrificed (group S, n = 33). Group P was further classified according to the degree of synovial coverage of the remnant on initial arthroscopic findings: group A (remnant fully covered with synovium, n = 15), group B (synovial coverage >50%, n = 15), and group C (coverage <50%, n = 12). Clinical outcomes including manual laxity tests, KT-2000 side-to-side difference, modified Lysholm score, Tegner activity score, and International Knee Documentation Committee score were evaluated pre-operatively and prior to the second-look arthroscopy. Graft tension, degrees of synovialization, and gross integrity were evaluated on second-look arthroscopic examination. RESULTS: There were no statistical differences in manual laxity tests, KT-2000 side-to-side difference, and clinical scores between groups P and S. In second-look arthroscopic examination, graft tension showed no difference between the two groups, but gross integrity and synovialization were significantly higher in group P (P = 0.032 and P = 0.008, respectively). In subgroup analysis, only group A showed higher grade regarding gross integrity and synovialization in comparison with group S (P = 0.007 and P < 0.001, respectively). CONCLUSIONS: Preservation of remnant in ACL reconstruction showed no superiority concerning knee stability and clinical outcomes over remnant sacrificing at post-operative 1-year second-look arthroscopy. Preservation of remnant with good synovial coverage had a positive effect on graft synovialization and maintenance of graft integrity, but this effect was not observed in cases of a remnant with poor synovial coverage. When deciding whether to preserve the remnant or not, the degree of synovial coverage should be considered. LEVEL OF EVIDENCE: III.
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