Remnant Tissue-Preserving Technique for Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction

Preservation of the anterior cruciate ligament (ACL) remnant tissue has attracted notice in ACL reconstruction. Remnant preservation has been expected to have several potential advantages to improve postoperative knee stability such as enhanced graft coverage, accelerated cell repopulation, and revascularization. Recently, we have developed a new remnant-preserving technique for anatomical double-bundle ACL reconstruction using the semitendinosus tendon. The anterior laxity values and the results of the pivot-shift test were significantly better in the remnant tissue-preserving procedure than in the remnant tissue-resecting procedure. The arthroscopic evaluation showed that the remnant-preserving procedure was significantly better than the remnant-resecting procedure concerning postoperative laceration or tear of the grafts as well as synovial and fibrous tissue coverage of the grafts. However, to establish the clinical use of remnant tissue preservation, further randomized clinical studies are needed to objectively examine the effects on rotatory stability and the long-term survival of graft function.