The Short-termclinical Efficacy Observation Of Arthroscopic Anterior Cruciate Ligament Reconstruction With And Without Remnant Preservation

Background:The anterior cruciate ligament remnant is rich in proprioceptors,a variety of pro-healing factors,and the mechanical action of the remnant itself.Therefore,the anterior cruciate ligament reconstruction with remnant preservation has significant advantages in theoretical hypothesis and basic research,but the existence of clear benefits is still controversial in actual clinical application.Objective: To discuss the clinical efficacy of anterior cruciate ligament reconstruction with remnant preservation in short-term by comparing the outcome of using different surgical procedures(remnant preservation or remnant removing)for reconstruction of the anterior cruciate ligament with autologous hamstring tendon.Methods:Retrospective analysis of patients with anterior cruciate ligament rupture undergoing arthroscopic anterior cruciate ligament reconstruction with autologous hamstrings from January 2014 to June 2018 in the Department of Orthopaedics/International wards of Chengdu University of Traditional Chinese Medicine(Sichuan Traditional Chinese Medicine Hospital)30 cases.Patients were divided into preserving-remnant group and removing-remnant group according to different surgical procedures.Knee joint function evaluation(joint activity,stability test),scale evaluation(IKDC classification,Lysholm score),and balance evaluation(mean trajectory error rate,total trunk standard deviation)were performed before and after operation.Results:The 30 cases were followed up at 3 months and 6 months after surgery.The patient recovered after surgery,and there were no surgical complications during the operation.The joint mobility of the two groups was significantly increased at 3 months and 6 months after operation,but the difference in the activity between the two groups was no significant.The preserving-remnant group Lachman test was performed at 3 months and 6 months after operation: 14 cases showed negative and 1 case showed 1°positive.The Lachman test of removing-remnant group showed 14 cases negative and 1 case 1°positive at 3 months after operation,but showed 13 cases negative and 2 case 1°positive at 6 months after operation.The results of the pivot-shift test are the same as those of the Lachman test.However,the statistical analysis of the ranks between the groups showed that the P value was 0.99(not statistically significant).At the two follow-ups,the Lysholm scores of the two groups were significantly higher than those before surgery,but There was no statistically significant difference(P=0.145)between the preserving-remnant group and the removing-remnant group.In the IKDC ligament grading evaluation of the two groups of patients: the preserving-remnant group has 10 cases in A class and 5 cases in B class at 3 mouths after operation.At the same follow-up time,the removing-remnant group shows 9 cases in A class? 4 cases in B class and 2 cases in C class.At 6 mouths after operation,the preserving-remnant group has 14 cases in A class and 1 cases in B class but the removing-remnant group still show 3 cases in B class.There were no grade C and D in the two groups.Two time points statistical analysis of the rank sum test P values were 0.541,0.291,respectively,no statistical difference.At 3 months and 6 months after operation,the mean trajectory error rate and total body standard deviation of the two groups were significantly improved,and the preserving-remnan group score was superior to the removing-remnant group,and the difference was statistically significant(p<0.01).)Conclusion: Arthroscopic anterior cruciate ligament reconstruction with and without remnant preservation can significantly improve the patient's symptoms,improve knee function,and restore knee stability.However,There was no significant difference between the preserving-remnant group and the removing-remnant group in short-term efficacy of the the functional evaluation and the scale evaluation.The preserving-remnant group in the evaluation of proprioceptive/balance function was significantly better than the removing-remnant group,and the difference was statistically significant.