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Meta-Analysis
, 13 (1), 231

Remnant Preservation Technique Versus Standard Technique for Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Randomized Controlled Trials

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Meta-Analysis

Remnant Preservation Technique Versus Standard Technique for Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Randomized Controlled Trials

Hong-De Wang et al. J Orthop Surg Res.

Abstract

Background: This meta-analysis was performed to compare the clinical outcomes of primary anterior cruciate ligament (ACL) reconstruction using the ACL remnant preservation technique versus the standard technique.

Methods: PubMed, Embase, and the Cochrane Library were searched through December 24, 2017, to identify randomized controlled studies that compared the use of the ACL remnant preservation technique versus the standard technique for primary ACL reconstruction. Statistical heterogeneity among the trials was evaluated with chi-square and I-square tests. A sensitivity analysis was conducted to explore sources of heterogeneity. Subgroup analysis was performed to identify potential differences according to type of ACL remnant tissue (remnant bundle or remnant fibers).

Results: Seven studies with a combined 412 patients (208 in the remnant preservation technique group and 204 in the standard technique group) were included in the meta-analysis. There was a significant difference between the groups in Lysholm score (mean difference (MD), 2.20; 95% confidence interval (CI), 0.95-3.45; P = 0.0006) and side-to-side difference (MD, - 0.71; 95% CI, - 0.87 to - 0.55; P < 0.01). There was no significant difference between the groups in subjective International Knee Documentation Committee (IKDC) score, complications, pivot shift test, Lachman test, or overall IKDC score. Subgroup analysis demonstrated that for primary ACL reconstruction with preservation of remnant fibers, the remnant preservation technique was superior to the standard technique based on Lysholm scores (P < 0.01) and side-to-side difference (P < 0.01).

Conclusions: Based on the current literature, using the remnant preservation technique showed a better clinical outcome than using the standard technique for patients undergoing primary ACL reconstruction with respect to Lysholm score and side-to-side difference. However, it remains unclear that there is a definite advantage to use the remnant preservation technique compared with the standard technique.

Keywords: Anterior cruciate ligament; Meta-analysis; Reconstruction; Remnant preservation.

Conflict of interest statement

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Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Selection process for the meta-analysis of studies comparing the ACL remnant preservation technique with the standard technique for ACL reconstruction
Fig. 2
Fig. 2
Primary outcomes after anterior cruciate ligament (ACL) reconstruction. RP-group, Remnant preservation technique group; St-group, Standard technique group. a Subjective International Knee Documentation Committee scores after ACL reconstruction. b Lysholm scores after ACL reconstruction. c Complications after ACL reconstruction
Fig. 3
Fig. 3
Secondary outcomes after anterior cruciate ligament (ACL) reconstruction. RP-group, Remnant preservation technique group; St-group, Standard technique group. a Pivot-shift test (Grade 0) after ACL reconstruction. b Lachman test (Grade 0) after ACL reconstruction. c Side-to-side difference after ACL reconstruction. d Overall International Knee Documentation Committee score (Normal, Nearly normal) after ACL reconstruction
Fig. 4
Fig. 4
Risk of bias for each randomized controlled trial (RCT). a Graph depicting risk of bias. b Summary of risk of bias in the included studies

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