Published: 2021-06-23

Functional result of anterior cruciate ligament reconstruction by remnant preservation in a tertiary center in Eastern India

Ritwik Ganguli, Swagatam Jash


Background: Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures in orthopaedics. Orthopaedic surgery is vastly evolving to give better functional outcome. Apart from stability, proprioception, ligament healing are important factors for return to sports. The presence of remnant containing mechanoreceptors and free neural endings can help reinnervate the ACL auto graft. Aims and objectives were to evaluate clinical outcomes in patients undergoing ACL reconstruction with remnant preservation.

Methods: One hundred and six patients who underwent ACL reconstruction between April 2014 and March 2020. Among these 80 patients underwent remnant preservation. Analysis is done based on international knee documentation committee score (IKDC), modified Cincinnati knee rating system (MCKRS) and Tegner-Lysholm scoring system. Other factors are Lachman test, pivot shift test, return to sports and graft rupture rate.

Results: Lachman test became negative in 98% at 12 weeks and in all the patients at 24 months post-operatively. 74 patients (92.5%) among 80 patients develop full range of knee movement after ACL surgery. Post-operative scores are 95, 93, and 92 respectively.

Conclusions: Remnant preserving ACL reconstruction having excellent clinical outcome with good knee stability, early return to sports activities and no incidence of graft rupture in our series.


ACL reconstruction, Remnant preservation, Excellent result

Full Text:



Lai CCH, Ardern CL, Feller JA, Webster KE. Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: A systematic review with meta-analysis of return to sport rates, graft rupture rates and performance outcomes. Br J Sports Med. 2018;52:128-38.

Takahashi T, Kondo E, Yasuda K. Effects of remnant tissue preservation on the tendon graft in anterior cruciate ligament reconstruction: A biomechanical and histological study. Am J Sports Med. 2016;44:1708-16.

Dhillon MS, Bali K, Vasistha RK. Immunohistological evaluation of proprioceptive potential of the residual stump of injured anterior cruciate ligaments (ACL). Int Orthop. 2010;34:737-41.

Bali K, Dhillon MS, Vasistha RK, Kakkar N, Chana R, Prabhakar S. Efficacy of immune-histological methods in detecting functionally viable mechanoreceptors in the remnant stumps of injured anterior cruciate ligaments and its clinical importance. Knee Surg Sports Traumatol Arthrosc. 2012;20:75-80.

Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A, Nakagawa T, Shiozawa H et al. The remnant preservation technique reduces the amount of bone tunnel enlargement following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2018;26(2):491-9.

Nakayama H, Kambara S, Iseki T, Kanto R, Kurosaka K, Yoshiya S. Double bundle anterior cruciate ligament reconstruction with and without remnant preservation-comparison of early postoperative outcomes and complications. Knee. 2017;24:1039-46.

Kondo E, Yasuda K, Onodera J, Kawaguchi Y, Kitamura N. Effects of remnant tissue preservation on clinical and arthroscopic results after anatomic double-bundle anterior cruciate ligament reconstruction. Am J Sports Med. 2015;43:1882-92.

Lee BI, Kwon SW, Kim JB, Choi HS, Min KD. Comparison of clinical results according to amount of preserved remnant in arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft. Arthroscopy. 2008;24:560-8.

Biau DJ, Tournoux C, Katsahian S, Schranz P, Nizard R. ACL Reconstruction. A Meta-analysis of Functional Scores. Clin Orthop Relat Res. 2007;458:180-7.

Shelbourne KD, Gray T, Haro M. Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med. 2009;37(2):246-51.

Salmon L, Russell V. Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy. 2005;21(8):948-57.

Chen T, Zhang P, Chen J, Hua Y, Chen S. Long-term outcomes of anterior cruciate ligament reconstruction using either synthetics with remnant preservation or hamstring autografts: a 10-year longitudinal study. Am J Sports Med. 2017;45(12):2739-50.