No clinical difference in 10-year outcomes between standard and minimal graft debridement techniques in patients undergoing anterior cruciate ligament reconstruction using autologous hamstrings: a randomized controlled trial

Peter T. Annear, Edward J. Rohr, David M. Hille, Satyen Gohil, Jay R. Ebert

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Abstract

Delayed ligamentization following anterior cruciate ligament reconstruction (ACLR) may result in reduced graft stiffness and strength, and an increased risk of secondary re-tear. Remnant sparing ACLR may accelerate ligamentization and proprioceptive function, theoretically reducing re-injury risk. This study sought to investigate 10-year graft failure rates and patient perceived knee functioning in those undergoing ACLR with remnant preservation (RP), versus remnant debridement (RD).

A prospective RCT allocated 49 patients to ACLR with a hamstrings autograft together with a RD (n = 25) or RP (n = 24) procedure, of which 86% were clinically evaluated at 10 years (22 RD, 22 RP). A detailed chart review and patient phone consultation was undertaken with all patients at 10 years to evaluate the incidence (and timing) of subsequent re-tear and/or contralateral ACL tear, as well as other knee injuries/surgeries, the patient's ability to perform full work/sport duties and their perceived knee function using a numerical rating scale (NRS).

No significant differences existed between groups in descriptive variables. There were 2 graft ruptures (10.0%) in the RP group and 3 (13.6%) in the RD group, with an earlier mean time to graft failure in the RD group (RD 7.7 +/- 4.5 months, RP 49.5 +/- 17.7 months), albeit the size of this sub-sample was too small for statistical comparison. There was a significantly higher number of patients requiring ae 1 additional ipsilateral knee surgery in the RP group (RP = 10, RD = 4, p = 0.048). At 10 years, there were no significant group differences in the percentage of patients returning to unrestricted activity, with 16 (72.7%) and 15 (75.0%) patients in the RD and RP ACLR groups, respectively, unrestricted in work/sport duties. There were no significant group differences in the functional NRS ratings.

No long term clinical benefit of RP ACLR could be determined by this study with similar re-tear incidence and perceived knee function. A statistically higher number of re-operations were observed in RP ACLR patients and, while re-tears were observed later after RP versus RD ACLR, the study was underpowered to detect statistical significance.

Level II (prospective randomized controlled trial).

Original languageEnglish
Pages (from-to)516-523
Number of pages8
JournalKnee Surgery Sports Traumatology Arthroscopy
Volume27
Issue number2
DOIs
Publication statusPublished - Feb 2019

Cite this

@article{d4e0e81e30a744fabf4c485d2cc97e6b,
title = "No clinical difference in 10-year outcomes between standard and minimal graft debridement techniques in patients undergoing anterior cruciate ligament reconstruction using autologous hamstrings: a randomized controlled trial",
abstract = "Delayed ligamentization following anterior cruciate ligament reconstruction (ACLR) may result in reduced graft stiffness and strength, and an increased risk of secondary re-tear. Remnant sparing ACLR may accelerate ligamentization and proprioceptive function, theoretically reducing re-injury risk. This study sought to investigate 10-year graft failure rates and patient perceived knee functioning in those undergoing ACLR with remnant preservation (RP), versus remnant debridement (RD).A prospective RCT allocated 49 patients to ACLR with a hamstrings autograft together with a RD (n = 25) or RP (n = 24) procedure, of which 86{\%} were clinically evaluated at 10 years (22 RD, 22 RP). A detailed chart review and patient phone consultation was undertaken with all patients at 10 years to evaluate the incidence (and timing) of subsequent re-tear and/or contralateral ACL tear, as well as other knee injuries/surgeries, the patient's ability to perform full work/sport duties and their perceived knee function using a numerical rating scale (NRS).No significant differences existed between groups in descriptive variables. There were 2 graft ruptures (10.0{\%}) in the RP group and 3 (13.6{\%}) in the RD group, with an earlier mean time to graft failure in the RD group (RD 7.7 +/- 4.5 months, RP 49.5 +/- 17.7 months), albeit the size of this sub-sample was too small for statistical comparison. There was a significantly higher number of patients requiring ae 1 additional ipsilateral knee surgery in the RP group (RP = 10, RD = 4, p = 0.048). At 10 years, there were no significant group differences in the percentage of patients returning to unrestricted activity, with 16 (72.7{\%}) and 15 (75.0{\%}) patients in the RD and RP ACLR groups, respectively, unrestricted in work/sport duties. There were no significant group differences in the functional NRS ratings.No long term clinical benefit of RP ACLR could be determined by this study with similar re-tear incidence and perceived knee function. A statistically higher number of re-operations were observed in RP ACLR patients and, while re-tears were observed later after RP versus RD ACLR, the study was underpowered to detect statistical significance.Level II (prospective randomized controlled trial).",
keywords = "Anterior cruciate ligament reconstruction, Remnant sparing, Remnant preservation, Clinical outcomes, Knee function, Re-injury, REMNANT-PRESERVING AUGMENTATION, ACL RECONSTRUCTION, PRESERVATION, REVASCULARIZATION, MECHANORECEPTORS, AUTOGRAFT",
author = "Annear, {Peter T.} and Rohr, {Edward J.} and Hille, {David M.} and Satyen Gohil and Ebert, {Jay R.}",
year = "2019",
month = "2",
doi = "10.1007/s00167-018-5146-5",
language = "English",
volume = "27",
pages = "516--523",
journal = "Knee Surgery, Sports Traumatology, Arthroscopy",
issn = "0942-2056",
publisher = "Springer",
number = "2",

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TY - JOUR

T1 - No clinical difference in 10-year outcomes between standard and minimal graft debridement techniques in patients undergoing anterior cruciate ligament reconstruction using autologous hamstrings

T2 - a randomized controlled trial

AU - Annear, Peter T.

AU - Rohr, Edward J.

AU - Hille, David M.

AU - Gohil, Satyen

AU - Ebert, Jay R.

PY - 2019/2

Y1 - 2019/2

N2 - Delayed ligamentization following anterior cruciate ligament reconstruction (ACLR) may result in reduced graft stiffness and strength, and an increased risk of secondary re-tear. Remnant sparing ACLR may accelerate ligamentization and proprioceptive function, theoretically reducing re-injury risk. This study sought to investigate 10-year graft failure rates and patient perceived knee functioning in those undergoing ACLR with remnant preservation (RP), versus remnant debridement (RD).A prospective RCT allocated 49 patients to ACLR with a hamstrings autograft together with a RD (n = 25) or RP (n = 24) procedure, of which 86% were clinically evaluated at 10 years (22 RD, 22 RP). A detailed chart review and patient phone consultation was undertaken with all patients at 10 years to evaluate the incidence (and timing) of subsequent re-tear and/or contralateral ACL tear, as well as other knee injuries/surgeries, the patient's ability to perform full work/sport duties and their perceived knee function using a numerical rating scale (NRS).No significant differences existed between groups in descriptive variables. There were 2 graft ruptures (10.0%) in the RP group and 3 (13.6%) in the RD group, with an earlier mean time to graft failure in the RD group (RD 7.7 +/- 4.5 months, RP 49.5 +/- 17.7 months), albeit the size of this sub-sample was too small for statistical comparison. There was a significantly higher number of patients requiring ae 1 additional ipsilateral knee surgery in the RP group (RP = 10, RD = 4, p = 0.048). At 10 years, there were no significant group differences in the percentage of patients returning to unrestricted activity, with 16 (72.7%) and 15 (75.0%) patients in the RD and RP ACLR groups, respectively, unrestricted in work/sport duties. There were no significant group differences in the functional NRS ratings.No long term clinical benefit of RP ACLR could be determined by this study with similar re-tear incidence and perceived knee function. A statistically higher number of re-operations were observed in RP ACLR patients and, while re-tears were observed later after RP versus RD ACLR, the study was underpowered to detect statistical significance.Level II (prospective randomized controlled trial).

AB - Delayed ligamentization following anterior cruciate ligament reconstruction (ACLR) may result in reduced graft stiffness and strength, and an increased risk of secondary re-tear. Remnant sparing ACLR may accelerate ligamentization and proprioceptive function, theoretically reducing re-injury risk. This study sought to investigate 10-year graft failure rates and patient perceived knee functioning in those undergoing ACLR with remnant preservation (RP), versus remnant debridement (RD).A prospective RCT allocated 49 patients to ACLR with a hamstrings autograft together with a RD (n = 25) or RP (n = 24) procedure, of which 86% were clinically evaluated at 10 years (22 RD, 22 RP). A detailed chart review and patient phone consultation was undertaken with all patients at 10 years to evaluate the incidence (and timing) of subsequent re-tear and/or contralateral ACL tear, as well as other knee injuries/surgeries, the patient's ability to perform full work/sport duties and their perceived knee function using a numerical rating scale (NRS).No significant differences existed between groups in descriptive variables. There were 2 graft ruptures (10.0%) in the RP group and 3 (13.6%) in the RD group, with an earlier mean time to graft failure in the RD group (RD 7.7 +/- 4.5 months, RP 49.5 +/- 17.7 months), albeit the size of this sub-sample was too small for statistical comparison. There was a significantly higher number of patients requiring ae 1 additional ipsilateral knee surgery in the RP group (RP = 10, RD = 4, p = 0.048). At 10 years, there were no significant group differences in the percentage of patients returning to unrestricted activity, with 16 (72.7%) and 15 (75.0%) patients in the RD and RP ACLR groups, respectively, unrestricted in work/sport duties. There were no significant group differences in the functional NRS ratings.No long term clinical benefit of RP ACLR could be determined by this study with similar re-tear incidence and perceived knee function. A statistically higher number of re-operations were observed in RP ACLR patients and, while re-tears were observed later after RP versus RD ACLR, the study was underpowered to detect statistical significance.Level II (prospective randomized controlled trial).

KW - Anterior cruciate ligament reconstruction

KW - Remnant sparing

KW - Remnant preservation

KW - Clinical outcomes

KW - Knee function

KW - Re-injury

KW - REMNANT-PRESERVING AUGMENTATION

KW - ACL RECONSTRUCTION

KW - PRESERVATION

KW - REVASCULARIZATION

KW - MECHANORECEPTORS

KW - AUTOGRAFT

U2 - 10.1007/s00167-018-5146-5

DO - 10.1007/s00167-018-5146-5

M3 - Article

VL - 27

SP - 516

EP - 523

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 0942-2056

IS - 2

ER -