BACKGROUND:There are controversies about preserving the remnant in the anterior cruciate ligament reconstruction procedure because of its uncertain therapeutic effects.
OBJECTIVE:Tocompare the efficacy and safety of preserving-remnant with removing-remnant for arthroscopic anterior cruciate ligament reconstruction using a meta-analysis.
METHODS:A computer-based online search was conducted in PubMed,Embase,the Cochrane Library, CDSR, CBM, and CNKI databases by using the English key wordsof “anterior cruciate ligamentAND remnant (OR stump)ANDrandomized controled trial (RCT)ORquasi-RCT” and the Chinese key words of“anterior cruciate ligament reconstruction, preserving-remnant, removing-remnant” to screen the relevant articles publishedfrom 1995 to July 2015. Meta-analysis was performed using Review Manager 5.3 software.
RESULTS AND CONCLUSION:A total of 13 randomized controled trials were included. The meta-analysis resultsshowed that there were no statisticaly significant differences in KT1000/2000 scores (OR=-0.28, 95%CI:-0.76-0.20,P=0.25), the good rate of synoveal coverage (OR=-0.30, 95%CI:-0.30-0.90,P=0.32), and the incidence of cyclops leions (OR=0.87,95%CI: 0.63-2.90,P=0.44). Postoperative Lysholm scores (OR=2.45, 95%CI: 0.52-4.39,P=0.01), proprioceptive function (OR=-1.72, 95%CI:-3.32 to 0.13,P=0.03), tunnel enlargement (OR=-0.66, 95%CI:-1.08 to-0.23,P=0.002) in preserving-remnant were superior to removing-remnant for arthroscopic anterior cruciate ligament reconstruction. These results suggest that both preserving-remnantandremoving-remnant for arthroscopic anterior cruciate ligament reconstructioncanobtain satisfactory antero-posterior stability of the knee. Preserving-remnant exhibits superiority in post-operative scores of the knee, proprioceptive function, tunnel enlargement.Furtherhigh-quality randomized controled trials are warranted because of some low-quality studies and the existing biases.

BACKGROUND:Reconstruction with remnant preservation can enhance tendon-bone healing. However, the study limits on the histological level, and there is a lack of research based on the modular biological level.
OBJECTIVE:To investigate whether anterior cruciate ligament reconstruction with remnant preservation can enhance tendon-bone healing.
METHODS:Seventy-two New Zealand rabbits were randomly al ocated to three groups (n=24 per group), fol owed by cruciate ligament reconstruction without remnant (group A), with remnant preservation (femoral tensioning and augmented suture) (group B) and with remnant preservation (graft passing remnant anterior cruciate ligament sheath) (group C), respectively.
RESULTS AND CONCLUSION:Hematoxylin-eosin staining showed that the tendon-bone healing in the groups B and C surpassed that in the group A, and group B was better than group C. Real-time PCR revealed that the expression level of osteoprotegrin mRNA and the osteoprotegrin/receptor activator of nuclear factor-κB ligand (RANKL) ratio were greater in the groups B and C than in the group A, and highest in the group C, while the expression levels of RANKL mRNA in the groups B and C were lower than that in the group A. In conclusion, these two kinds of anterior cruciate ligament reconstruction methods with remnant preservation can enhance tendon-bone healing, which have obtained most obvious achievements in the anterior cruciate ligament reconstruction in the graft passing anterior cruciate ligament remnant sheath that may be related to the up-regulation of osteoprotegrin mRNA and down-regulation of RANKL mRNA.

BACKGROUND:At present, it is still unclear whether remnant-preserving anterior cruciate ligament (ACL) reconstruction can achieve better joint stability and reduce the degeneration of the articular cartilage compared with the traditional operation. OBJECTIVE: To compare knee joint degeneration after ACL reconstruction with and without remnant preservation. METHODS: A total of 60 New Zealand rabbits were randomly assigned in equal numbers to a sham group (group A), a conventional ACL reconstruction group (group B), a remnant-preserving and tensioning ACL reconstruction group (group C), and a remnant-preserving and graft through sleeve ACL reconstruction group (group D). In the group A, the joint capsule was cut open without dissection of the ACL, and corresponding rabbit models were established in the other three groups. Healing conditions of the remnant and tendon graft between groups C and D were observed at 12 weeks post-surgery, and the biomechanical properties of the tendon graft were determined by the pull-off test. Cartilage degeneration was assessed by Mankin score, following hematoxylin-eosin and Masson staining of the medial tibial plateau, and chondrocyte apoptosis examined using TUNEL assay. Expression of matrix metalloproteinase 13, proteoglycan and Bax proteins was measured using western blot assay. RESULTS AND CONCLUSION: Healing of remnant to the tendon grafts was not observed in groups C and D at 12 weeks post-surgery. In addition to the presence of articular cartilage degeneration, the Mankin score, cartilage apoptotic index, and expression of matrix metalloproteinase 13 and Bax proteins in groups B, C and D were all significantly higher than those of group A (P < 0.05), and the expression of proteoglycan in the three groups was lower than that in group A (P < 0.05), with no significant difference among the B, C, and D groups (P > 0.05). To conclude, there are no significant differences in articular cartilage degeneration following remnant-preserving and conventional ACL construction, and this may be associated with the absence of increased knee stability by remnant preservation.