The Effect Of Anterior Cruciate Ligament (ACL) Reconstruction With Or Witout Remnant Preservation On The Recovery Of Knee Proprioception

Part 1:The study on the form and quantity of the mechanoreceptors of the ACL remnants(Objective] To provide the experimental evidence of ACL reconstruction with remnant preservation by researching on the form and quantity of the mechanoreceptors in ACL.[Methods] 1. There were 30 patients who had ACL reconstruction under arthroscopy and 15 patients who had amputation at the Affiliated Hospital of Kuming Medical University from January 2013 to December 2014. The patients’ ACL tissue were divided into two groups, group A1 and group A2, based on the injury time of ACL which accepted ACL single-bundle reconstruction. In group Al, the injury time was≤ 3 months (15 patients), A2 tissue injury time was> 3 months (15 patients), and A3 was the amputation group (15 patients).2. H&E staining and immunohistochemical methods were applied to the specimen, the quantity and form of mechanoreceptors in the specimen were observed and the data were analyzed with SPSS 20.0.[Results] After observation, there were 70 Ruffini corpuscles,34 Pacinian corpuscles, and 12 Golgi corpuscles in group A1; there were 46 Ruffini corpuscles, 14 Pacinian corpuscles,10 Golgi corpuscles in group A2. there were 93 Ruffini corpuscles,42 Pacinian corpuscles,18 Golgi corpuscles in group A3. The number of Ruffini corpuscles and mechanoreceptors in group A3 was much more than group A1 and group A2. The number of Ruffini corpuscles and the mechanoreceptors in group A1 was much more than group A2, There was statistical difference (P<0.05).And the number of Pacinian corpuscles and Golgi tendon organ in group A1、group A2 and group A3 had no statistical significant difference (P<0.05)[Conclusions] 1. Ruffini corpuscles, Pacinian corpuscles, Golgi tendon organ like corpuscles as well as free nerve endings were found in the ACL remnant, which provided the foundation of ACL reconstruction with remnant preservation, and ACL reconstruction with remnant preservation could help to recovery the proprioception of the knee.2. The number of mechanoreceptors in the ACL decreased with the injury time, and the number of mechanoreceptors significantly decreased 3 month after injury, which interfered the recovery of proprioception after the ACL reconstruction with remnant preservation.Part 2Comparison the clinical between ACL reconstruction with remnant preservation and without remnant preservation.[Objective] To compare and analyze the clinical effects of ACL reconstruction under the arthroscopy with and without remnant preservation.[Methods] 1.80 patients who met the standards had ACL single-bundle reconstruction with hamstring tendon autografts under arthroscopy at the Affiliated Hospital of Kunming Medical University from January 2013 to December 2014. Among them, there were 40 patients who had ACL reconstruction with remnant preservation, included 22 male patients and 18 female patients; There were 40 patients who had ACL reconstruction without remnant preservation, included 26 male patients and 14 female patients. The gender, age of both groups had no statistical significance (P> 0.05) and they were comparable. All the patients’ operation was done by the same senior surgeon, and Endobutton used to fix grafted tendon at distal femur and interference screws were used to fix grafted tendon at proximal tibia. Anterior Drawer Test, Lysholm rating, International Knee Documentation Committee (IKDC) scores as well as the Threshold for Detecting Passive Motion (TTDPM) value were used to evaluate the clinical effects of ACL reconstruction with and without remnant preservation.2. The data were analyzed with SPSS 20.0, and the Lysholm scores and IKDC scores were compared before and after operation by pair T test, Lysholm scores and IKDC scores before and after the operation were analyzed with two independent sample t-tests. The Anterior Drawer Tests before and after operation were analyzed with χ2 inspection test, Between the remnant preservation group and the non-preservation group, TTDPM value were compared with pair T test, the statistical significance was P< 0.05.[Results] 1.The 80 patients were followed-up, there are 1 positive and 39 negative in Anterior Drawer Tests in the remnant preservation group. There were 2 positive and 38 negative in Anterior Drawer Tests in the non-preservation group. Lysholm score and IKDC score of all 80 patients before and after operation had significant difference(p< 0.05), which indicated the knee joint function and stability had been improved significantly.2.There was statistical difference between the TTDPM value of remnant preservation group and non-preservation group (p< 0.05), indicated that ACL reconstruction with remnant preservation could helped recovery its proprioception function.[Conclusion] 1. ACL reconstruction under arthroscopy could recovery the mechanics function of the knee joint, it also provided the conditions for the early stage recovery of its proprioception function, and helped the recovery the overall function of the knee joint.2. ACL reconstruction with remnant preservation could facilitate the grafted tendon tissues’ vascularization; it also preserved the mechanoreceptors of the ACL remnant, and thus better facilitated its proprioception function; it also helped the grafted tissues to better fit with the bone tunnel and therefore, avoids windshield wiper effect and helped the healing of tendon and bone. 3. ACL reconstruction with remnant preservation could help the patients to regain proprioception function earlier, so the patients could exercise in early recovery stage, and thus prevent the muscle atrophy and other complications.