Table 1.
Summary of six comparative studies investigating differences between a remnant-preserving and a standard technique.
| Study reference no. | publication year | Study design | Study period: (remnant; control) | Remnant recruited (male, female) Control recruited (male; female) |
Age (y) (remnant/control) | Remnant control involved | Follow-up | Graft material | Reconstruction method | Outcome measures | Clinical measurements | MRI or radiographic evaluation Second-look evaluation |
Clinical evaluation | Conclusion |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Gohil et al38 | 2007 | RCT | Not listed | R: 24 (14, 10) C: 25 (13, 12) |
R: 30.5 C: 35.5 |
R: 24 C: 25 |
1 y | Auto; hamstring | SB quadrupled hamstring | MRI (3 time points of 2 mo, 6 mo, 12 mo); clinical assessment | KT-1000 IKDC evaluation |
Remnant: earlier revascularization of midsubstance at 2 mo; signal reduction at 6 mo No difference of cyclops |
No differences in IKDC scores, ROM, KT measurements |
Earlier revascularization at 2 mo; no evidence of earlier recovery of the graft strength |
| Ahn et al39 | 2010 | Retrospective comparative cohort study | R: 07/2007–12/2008, C: 09/200–08/2005 |
R: 35 C: 6 |
R:29.2 C: not listed |
R: 41 C: 41 |
6.3 ± 0.7 | Auto; hamstring | SB quadrupled hamstring | MRI (1 time point of 6 mo; 5 measurements) |
Remnant: larger graft, SNQ (ns), cyclops (ns) |
More progressive remodelling of ACL graft with no increase of cyclops | ||
| Cha et al32 | 2012 | Retrospective comparative cohort study | 02/2007–8/2008; 05/2004–06/2009 | R: 100 (85, 15) C: 36 (31, 5) |
R: 31.9 C: 27.6 |
MRI/ pathology R: 100/4 C: 36/20 |
MRI: 214 d postop | Auto; hamstring | SB quadrupled hamstring | MRI; pathology | Graft lesion score (0, 1, 2, 3 = cyclops): R (4%, 60%, 2%, 7%), C (3%, 50%, 39%, 8%) (ns) Cyclops (+, –): R (12%, 88%), C (15%, 85%) (ns) |
The prevalence of cyclops lesions was not different | ||
| Hong et al25 | 2012 | RCT | 08/2008–04/2010 | R: 45 (33, 12) C: 45 (34, 11) |
R: 34 C: 28 |
Clinical/second look R: 39/28 C: 41/28 |
R: 25.8 C: 25.5 |
Allo | SB quadrupled hamstring | Clinical, second look, proprioception | Manual laxity tests KT-1000, Lysholm proprioception evaluation (passive angle) |
R: KT 1.6, Lysholm 99, passive angle 3.6 C: KT 1.8, Lysholm 95, passive angle 3.9 |
A short-term study showed no evident advantages | |
| Zhang et al26 | 2014 | RCT | 2006–2009 | R: 31 C: 31 |
R: 24 C: 25 |
R: 27 (21/6) C: 24(19/5) |
R: 24.4 C: 25.2 |
Auto; hamstring | SB quadrupled hamstring | Clinical, radiographic | KT-1000; Lysholm | R: KT 1.4, Lysholm 93 C: KT 1.7, Lysholm 91 (ns) |
Remnant preservation may decrease tunnel enlargement. They do not affect the short-term clinical outcome | |
| Lu et al27 | 2015 | RCT | 03/2009–05/2011 | R: 36 (36,0)* C: 36 (36,0) |
R: 29 C: 31 |
R: 36 C: 36 |
R: 35 C: 40 |
Auto; hamstring | DB double × 2 | 3D CT, clinical, second look | Pivot shift, KT-2000 Tegner, Lysholm, IKDC subjective |
R: PL has variation on femoral and tibial sides. C: both tunnels consistently placed with small differences Second-look evaluation was better in the R group. |
KT: R 0.68, C: 1.23 (ns) Tegner and Lysholm scores, ROM recovery was better in the remnant group. | Remnant-preservation group was superior to control in both clinical and second-look evaluations |
Remnant: a group using remnant-preserving technique, Control: a group of using standard technique.
Graft lesion score (0, 1, 2, 3 = cyclops).
ACL = anterior cruciate ligament; C = control group; MRI = magnetic resonance imaging; ns = not significantly different; R = remnant-preserving group; RCT = randomized controlled clinical trial; SNQ = signal of anterior cruciate ligament graft—signal of quadriceps tendon/signal of background; 3D CT = three-dimensional computed tomography.