Posterolateral Bundle Reconstruction With Anteromedial Bundle Remnant Preservation in ACL Tears: Clinical and MRI Evaluation of 39 Patients With 24-Month Follow-up

Orthop J Sports Med. 2013 Aug 28;1(3):2325967113501624. doi: 10.1177/2325967113501624. eCollection 2013 Aug.


Background: Augmentation consisting of a selective reconstruction of the ruptured bundle while preserving the remnant bundle has been proposed as a treatment option for partial anterior cruciate ligament (ACL) tears. Good clinical outcomes after selective anteromedial (AM) bundle augmentation have been reported, whereas little is known about selective reconstruction of the posterolateral (PL) bundle with preservation of the AM bundle remnant.

Purpose: The purpose of this study was to evaluate the clinical outcomes and the magnetic resonance imaging (MRI) characteristics of selective PL bundle reconstruction with a median follow-up of 24 months.

Study design: Case series; Level of evidence, 4.

Methods: In a consecutive series of 741 ACL reconstructions, 44 patients underwent a selective PL bundle reconstruction with preservation of the AM remnant. Four patients with contralateral knee ligament surgery and 1 patient who sustained a traumatic rupture of his graft were excluded, leaving 39 patients for final evaluation. Clinical evaluation of knee function and laxity were recorded preoperatively and at a mean 24.2-month follow-up. Magnetic resonance imaging was performed on 35 patients at a mean 25.9-month follow-up for evaluation of graft and remnant bundle continuity, tunnel enlargement, and graft remodeling status by measuring the signal intensity of the graft (contrast/noise quotient [CNQ]).

Results: Tegner and Lysholm knee scores were significantly improved after surgery. The subjective International Knee Documentation Committee (IKDC) score was 43.5 ± 16.6 preoperatively and 89.9 ± 6.6 at the final follow-up (P < .01). The objective IKDC score was "B" for 17 patients, "C" for 21 patients, and "D" for 1 patient preoperatively, while it was "A" for 34 patients and "B" for 5 patients postoperatively (P < .01). The mean side-to-side anteroposterior laxity was 5 mm (range, 4-10 mm) preoperatively and 1.5 mm (range, -1 to 4 mm) at final follow-up (P < .01). On MRI, the graft was visible and continuous in all cases. No cyclops lesions were noted. The average CNQ for the PL graft and the AM remnant bundle was 3.2 ± 1 and 2.9 ± 1.2, respectively. Minimum bone tunnel enlargement was found.

Conclusion: Selective PL bundle reconstruction restores knee stability and function. At final follow-up, MRI showed continuity of the PL graft without signs of dramatic tunnel enlargement or cyclops syndrome.

Keywords: ACL partial tear; anterior cruciate ligament; posterolateral (PL) bundle.