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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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

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).

Methods

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).

Results

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 ≥ 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.

Conclusions

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 of evidence

Level II (prospective randomized controlled trial).

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Funding

There was no funding for this study.

Author information

Authors and Affiliations

  1. Perth Orthopaedic and Sports Medicine Centre, Perth, 6005, Australia

    Peter T. Annear & Edward J. Rohr

  2. Royal Perth Hospital, Perth, 6000, Australia

    David M. Hille

  3. Orthopaedics WA, Wexford Medical Centre, Murdoch, 6150, Australia

    Satyen Gohil

  4. School of Human Sciences (Exercise and Sport Science), The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Australia

    Jay R. Ebert

Authors
  1. Peter T. Annear
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  2. Edward J. Rohr
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  3. David M. Hille
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Correspondence to Jay R. Ebert.

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All authors declare no individual conflicts.

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Ethics approval was obtained by the Hollywood Private Hospital (HPH382).

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Annear, P.T., Rohr, E.J., Hille, D.M. et al. 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. Knee Surg Sports Traumatol Arthrosc 27, 516–523 (2019). https://doi.org/10.1007/s00167-018-5146-5

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  • DOI: https://doi.org/10.1007/s00167-018-5146-5

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