Partial tears of anterior cruciate ligament: Results of single bundle augmentation

Dhananjaya Sabat, Vinod Kumar, Dhananjaya Sabat, Vinod Kumar

Abstract

Background: Partial tears of the anterior cruciate ligament (ACL) are common and usually present with symptomatic instability. The remnant fibers are usually removed and a traditional ACL reconstruction is done. But with increased understanding of ACL double bundle anatomy, the remnant tissue preservation along with a single bundle augmentation of the torn bundle is also suggested. The purpose of this study was to evaluate the results of selective anatomic augmentation of symptomatic partial ACL tears. Our hypothesis is that this selective augmentation of partial ACL tears could restore knee stability and function.

Materials and methods: Consecutive cases of 314 ACL reconstructions, 40 patients had intact ACL fibers in the location corresponding to the anteromedial (AM) or posterolateral (PL) bundle and were diagnosed as partial ACL tears perioperatively. All patients underwent selective augmentation of the torn bundle, while keeping the remaining fibers intact using autogenous hamstring graft. A total of 38 patients (28 males, 10 females) were available with a minimum of 3 years followup. 26 cases had AM bundle tears and 12 cases had PL bundle tears respectively. Patients were assessed with International Knee Documentation Committee (IKDC) 2000 Knee Evaluation Form, Lysholm score; instrumented knee testing was performed with the arthrometer (KT 2000). Statistical analysis was performed to compare the preoperative and postoperative objective evaluation.

Results: At 3 years followup, 31.6% patients were graded A, 65.8% were graded B and 2.6% was graded C at IKDC objective evaluation. Manual laxity tests, Lysholm's score, mean side to side instrumental laxity and Tegner activity score improved significantly. 76% patients returned to preinjury level of sports activity after augmentation.

Conclusion: The results of anatomic single bundle augmentation in partial ACL tears are encouraging with excellent improvement in functional scores, side to side laxity and return to sports activity.

Keywords: Anterior cruciate ligament; Anteromedial bundle; anterior cruciate ligament reconstruction; cruciate ligament; partial anterior cruciate ligament tear; posterolateral bundle; selective augmentation.

Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
Arthroscopy views showing (a) tear of anteromedial bundle and intact posterolateral bundle (b) tibial tunnel position for anteromedial bundle augmentation (c) femoral tunnel position for anteromedial bundle augmentation (d) final picture of anteromedial bundle augmentation keeping posterolateral bundle intact
Figure 2
Figure 2
Arthroscopic pictures showing (a) intact anteromedial bundle and tear of posterolateral bundle (with anteromedial bundle retracted) (b) femoral tunnel for posterolateral augmentation (c) tibial tunnel position for posterolateral bundle augmentation (d) final picture of posterolateral bundle augmentation keeping anteromedial bundle intact

References

    1. Noyes FR, Bassett RW, Grood ES, Butler DL. Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg Am. 1980;62:687–95. 757.
    1. Zantop T, Brucker PU, Vidal A, Zelle BA, Fu FH. Intraarticular rupture pattern of the ACL. Clin Orthop Relat Res. 2007;454:48–53.
    1. Jacquot L, Selmi TA, Servien E, Neyret P. EMC, Musculoskeletal, 14-080-A-20. Paris: Elsevier Masson SAS; 2003. Recent knee ligament injuries (Le’sions ligamentaires re’centes du genou) (article in french) p. 20.
    1. Liljedahl SO, Lindvall N, Wetterfors J. Early diagnosis and treatment of acute ruptures of the anterior cruciate ligament; a clinical and arthrographic study of forty-eight cases. J Bone Joint Surg Am. 1965;47:1503–13.
    1. Ochi M, Adachi N, Deie M, Kanaya A. Anterior cruciate ligament augmentation procedure with a 1 incision technique: Anteromedial bundle or posterolateral bundle reconstruction. Arthroscopy. 2006;22(463):e1–5.
    1. Siebold R, Fu FH. Assessment and augmentation of symptomatic anteromedial or posterolateral bundle tears of the anterior cruciate ligament. Arthroscopy. 2008;24:1289–98.
    1. Sonnery-Cottet B, Lavoie F, Ogassawara R, Scussiato RG, Kidder JF, Chambat P. Selective anteromedial bundle reconstruction in partial ACL tears: A series of 36 patients with mean 24 months followup. Knee Surg Sports Traumatol Arthrosc. 2010;18:47–51.
    1. Bak K, Scavenius M, Hansen S, Nørring K, Jensen KH, Jørgensen U. Isolated partial rupture of the anterior cruciate ligament. Long term followup of 56 cases. Knee Surg Sports Traumatol Arthrosc. 1997;5:66–71.
    1. Buckley SL, Barrack RL, Alexander AH. The natural history of conservatively treated partial anterior cruciate ligament tears. Am J Sports Med. 1989;17:221–5.
    1. Barrack RL, Buckley SL, Bruckner JD, Kneisl JS, Alexander AH. Partial versus complete acute anterior cruciate ligament tears. The results of nonoperative treatment. J Bone Joint Surg Br. 1990;72:622–4.
    1. Noyes FR, Mooar LA, Moorman CT, 3rd, McGinniss GH. Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency. J Bone Joint Surg Br. 1989;71:825–33.
    1. Fruensgaard S, Johannsen HV. Incomplete ruptures of the anterior cruciate ligament. J Bone Joint Surg Br. 1989;71:526–30.
    1. Danylchuk KD, Finlay JB, Krcek JP. Microstructural organization of human and bovine cruciate ligaments. Clin Orthop Relat Res. 1978;131:294–8.
    1. Delincé P, Krallis P, Descamps PY, Fabeck L, Hardy D. Different aspects of the cyclops lesion following anterior cruciate ligament reconstruction: A multifactorial etiopathogenesis. Arthroscopy. 1998;14:869–76.
    1. Smith DB, Carter TR, Johnson DH. High failure rate for electrothermal shrinkage of the lax anterior cruciate ligament: A multicenter followup past 2 years. Arthroscopy. 2008;24:637–41.
    1. Chen J, Chen S, Weitao Z, Yinghui H, Yunxia L. Technique of arthroscopic anterior cruciate ligament reconstruction with preserved residual fibers as a graft envelope. Tech Knee Surg. 2008;7:70–7.
    1. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752–7.
    1. Sabat D, Kumar V. Nerve injury during hamstring graft harvest: A prospective comparative study of three different incisions. Knee Surg Sports Traumatol Arthrosc. 2013;21:2089–95.
    1. van Eck CF, Schreiber VM, Liu TT, Fu FH. The anatomic approach to primary, revision and augmentation anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18:1154–63.
    1. Van Dyck P, Vanhoenacker FM, Gielen JL, Dossche L, Van Gestel J, Wouters K, et al. Three tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: Can we differentiate complete from partial tears? Skeletal Radiol. 2011;40:701–7.
    1. Van Dyck P, De Smet E, Veryser J, Lambrecht V, Gielen JL, Vanhoenacker FM, et al. Partial tear of the anterior cruciate ligament of the knee: Injury patterns on MR imaging. Knee Surg Sports Traumatol Arthrosc. 2012;20:256–61.
    1. Sonnery-Cottet B, Chambat P. Arthroscopic identification of the anterior cruciate ligament posterolateral bundle: The figure-of-four position. Arthroscopy. 2007;23:1128.e1–3.
    1. Borbon CA, Mouzopoulos G, Siebold R. Why perform an ACL augmentation? Knee Surg Sports Traumatol Arthrosc. 2012;20:245–51.
    1. Liu W, Maitland ME, Bell GD. A modeling study of partial ACL injury: Simulated KT-2000 arthrometer tests. J Biomech Eng. 2002;124:294–301.
    1. Crain EH, Fithian DC, Paxton EW, Luetzow WF. Variation in anterior cruciate ligament scar pattern: Does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy. 2005;21:19–24.
    1. Bray RC, Leonard CA, Salo PT. Vascular physiology and long term healing of partial ligament tears. J Orthop Res. 2002;20:984–9.
    1. Buda R, Ferruzzi A, Vannini F, Zambelli L, Di Caprio F. Augmentation technique with semitendinosus and gracilis tendons in chronic partial lesions of the ACL: Clinical and arthrometric analysis. Knee Surg Sports Traumatol Arthrosc. 2006;14:1101–7.
    1. Ochi M, Adachi N, Uchio Y, Deie M, Kumahashi N, Ishikawa M, et al. A minimum 2-year followup after selective anteromedial or posterolateral bundle anterior cruciate ligament reconstruction. Arthroscopy. 2009;25:117–22.
    1. Serrano-Fernandez JM, Espejo-Baena A, Martin-Castilla B, De La Torre-Solis F, Mariscal-Lara J, Merino-Ruiz ML. Augmentation technique for partial ACL ruptures using semitendinosus tendon in the over-the-top position. Knee Surg Sports Traumatol Arthrosc. 2010;18:1214–8.
    1. Chouteau J, Testa R, Viste A, Moyen B. Knee rotational laxity and proprioceptive function 2 years after partial ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012;20:762–6.
    1. 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.
    1. Sonnery-Cottet B, Panisset JC, Colombet P, Cucurulo T, Graveleau N, Hulet C, et al. Partial ACL reconstruction with preservation of the posterolateral bundle. Orthop Traumatol Surg Res. 2012;98(8 Suppl 1):S165–70.
    1. Yoon KH, Bae DK, Cho SM, Park SY, Lee JH. Standard anterior cruciate ligament reconstruction versus isolated single-bundle augmentation with hamstring autograft. Arthroscopy. 2009;25:1265–74.
    1. Demirağ B, Ermutlu C, Aydemir F, Durak K. A comparison of clinical outcome of augmentation and standard reconstruction techniques for partial anterior cruciate ligament tears. Eklem Hastalik Cerrahisi. 2012;23:140–4.
    1. Pujol N, Colombet P, Potel JF, Cucurulo T, Graveleau N, Hulet C, et al. Anterior cruciate ligament reconstruction in partial tear: Selective anteromedial bundle reconstruction conserving the posterolateral remnant versus single-bundle anatomic ACL reconstruction: Preliminary 1-year results of a prospective randomized study. Orthop Traumatol Surg Res. 2012;98(8 Suppl):S171–7.
    1. Maestro A, Suárez-Suárez MA, Rodríguez-López L, Villa-Vigil A. Stability evaluation after isolated reconstruction of anteromedial or posterolateral bundle in symptomatic partial tears of anterior cruciate ligament. Eur J Orthop Surg Traumatol. 2013;23:471–80.
    1. Adachi N, Ochi M, Uchio Y, Sumen Y. Anterior cruciate ligament augmentation under arthroscopy. A minimum 2-year followup in 40 patients. Arch Orthop Trauma Surg. 2000;120:128–33.
    1. Park SY, Oh H, Park SW, Lee JH, Lee SH, Yoon KH. Clinical outcomes of remnant-preserving augmentation versus double-bundle reconstruction in the anterior cruciate ligament reconstruction. Arthroscopy. 2012;28:1833–41.

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