Comparative analysis of single-bundle reconstruction by different remnant-preserving techniques for anterior cruciate ligament ruptures

doi:10.3877/ cma.j.issn.1674-134X.2025.02.005

Abstract

Abstract:

Objective

To compare and analyze the clinical efficacy of the treatment of acute anterior cruciate ligament (ACL) rupture by single-bundle reconstruction among with suspension remnant-preserving,sleeve remnant-preserving,and non-remnant-preserving under arthroscopic.

Methods

A retrospective analysis was conducted on clinical data from 125 patients undergoing arthroscopic autograft single-bundle reconstruction for ACL rupture in the Department of Orthopedics and Sports Medicine between January 2020 and June 2022. Inclusion criteria: age were 16 to 50 years; all the patients underwent surgery within three weeks after injury; MRI confirmed complete disruption of continuity and integrity of ACL; patients had high demands for functional recovery of the knee joint. Exclusion criteria: patients with concomitant bone fractures,collateral ligament injuries, or other autoimmune joint diseases. There were 87 males and 38 females among the enrolled patients. Based on surgical techniques, patients were stratified into three groups: suspension group using suspension remnant-preserving reconstruction (n=43), sleeve group adopting sleeve remnantpreserving reconstruction (n=41), and debridement group adopting non-remnant-preserving reconstruction with debridement (n=41). All three groups underwent identical postoperative functional rehabilitation protocols. Clinical efficacy was comprehensively assessed by comparing operative duration, Lysholmscores and International Knee Documentation Committee (IKDC) knee function scores preoperatively and at six, 12 months postoperatively, KT-2000 arthrometer measurements for knee stability, threshold to detect passive motion (tTDPM) for proprioception assessment, and regular postoperative MRI examinations of the affected knee. Statistical analyses included one-way analysis of variance (ANOVA) and chi square tests.

Results

All the patients in this study completed follow-up ranging from 12 to 36 months, (17.5±2.4) months on average. The sleeve group exhibited seven cases of complications, including cyclops lesion, comma sign, or hyperextension impingement, whereas no such complications were observed in the suspension group or debridement group.Operative durations were compared among three groups, with no statistically significant differences (F=0.257,P>0.05). At six months after surgery, the suspension group demonstrated the highest Lysholm scores (84.5±3.3)and IKDC scores (81.1±2.9) , followed by the sleeve group［Lysholm score (82.1±3.0), IKDC (79.6±3.2)］and debridement group［Lysholm score (80.6±4.1), IKDC (78.0±3.7)］, with statistically significant differences among the three groups (F=1.427, 2.502, both P<0.05). KT-2000 arthrometer measurements revealed the lowest side-to-side anterior laxity in the suspension group (2.18 ± 0.24 mm), significantly lower than the sleeve group (2.25±0.38) mm and debridement group (2.32±0.21) mm (F=5.483, P<0.05). TTDPM assessments showed superior proprioception in the suspension group (3.69±0.31)°, outperforming the sleeve group (4.05±0.42) ° and debridement group (4.37±0.28°) (F=2.912, P<0.05). At 12 months postoperatively,Lysholm scores, IKDC scores, and KT-2000 arthrometer measurements were comparable among the three groups, with no statistically significant differences (P>0.05). TTDPM assessments demonstrated significantly better proprioception in the suspension group (1.79±0.22)°, which was lower than the sleeve group (2.05±0.51)°and debridement group (2.28±0.19)°, showing statistically significant intergroup differences (F=1.887,P<0.05).MRI examinations of theinvovledknees at three, six, and 12 months after surgerydemonstrated wellvisualized tendon grafts with robust structural morphology. At all time points, the suspension group exhibited significantly lower graft signal intensity and signal-to-noise quotient (SNQ) compared to the sleeve group and debridement group.

Conclusions

Arthroscopic autograft single-bundle remnant-preserving reconstruction for ACL rupture facilitates graft-bone healing, ligament remodeling, and proprioceptive recovery, thereby enhancing functional rehabilitation of the affected limb. The suspension remnant-preserving technique restores and maintains tension in residual ligamentous tissues, effectively preventing complications such as cyclops lesion, comma sign, and hyperextension impingement.

Key words: Anterior cruciate ligament injuries, Arthroscope, Anterior cruciate ligament reconstruction

Zheng Li, Li Li, Chuanshuang Ou, Qiong Yang, Changshu Li. Comparative analysis of single-bundle reconstruction by different remnant-preserving techniques for anterior cruciate ligament ruptures[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(02): 162-171.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/ cma.j.issn.1674-134X.2025.02.005

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2025/V19/I02/162

Figures/Tables 16

Figure 1 High strength thread inserted into the pulp loop under knee arthroscope

Figure 2 High strength thread braided suture anterior cruciate ligament stumP

Figure 3 Anterior cruciate ligament stump suspended tension knot fixation under knee arthroscope

Figure 4 Arthroscopic exploration and reconstruction of anterior cruciate ligament tension

Figure 5 The residual root tissue of ACL (anterior cruciate ligament) was preserved and reconstructed under knee arthroscope

Figure 6 ACL (anterior cruciate ligament) residual root tissue was completely removed and reconstructed under knee arthroscope

Table 1 Comparison of general data of patients

组别Groups	例数Number of cases	性别（男/女）Gender (male/female)	年龄［岁，（ $\overset{ˉ}{x}$ ± s ）］Age（years）	左膝/右膝（例）Left knee/right knee	运动伤/交通伤（例）Sports-related injury/traffc injury	受伤至手术时间［个月，（ $\overset{ˉ}{x}$ ± s ）］Time from injury to surgery（months）
悬吊组Suspension group	43	25/18	28. 1±3. 8	23/20	33/10	2. 6±1. 5
袖套组Sleeve group	41	22/19	29. 4±4. 3	24/17	32/9	3. 5±2. 2
非保残组Debridement group	41	23/18	28. 3±5. 1	20/21	29/12	3. 1±1. 4
统计值Statistic al values		χ ²=0. 40	F=0. 25	χ ²=0. 95	χ ²=0. 18	F=0. 24
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

Table 1 Comparison of general data of patients

组别Groups	例数Number of cases	性别（男/女）Gender (male/female)	年龄［岁，（ $\overset{ˉ}{x}$ ± s ）］Age（years）	左膝/右膝（例）Left knee/right knee	运动伤/交通伤（例）Sports-related injury/traffc injury	受伤至手术时间［个月，（ $\overset{ˉ}{x}$ ± s ）］Time from injury to surgery（months）
悬吊组Suspension group	43	25/18	28. 1±3. 8	23/20	33/10	2. 6±1. 5
袖套组Sleeve group	41	22/19	29. 4±4. 3	24/17	32/9	3. 5±2. 2
非保残组Debridement group	41	23/18	28. 3±5. 1	20/21	29/12	3. 1±1. 4
统计值Statistic al values		χ ²=0. 40	F=0. 25	χ ²=0. 95	χ ²=0. 18	F=0. 24
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

Table 2 Comparisons of IKDC and Lysholm scores of knee joint function in the pateints

组别Groups	例数Number of cases	Lysholm评分			IKDC评分
组别Groups	例数Number of cases	术前Before operation	术后6个月Six months after operation	术后12个月12 months after operation	术前Before operation	术后6个月Six months after operation	术后12个月12 months after operation
悬吊组Suspension group	43	45. 9±2. 7	84. 5±3. 3^acd	87. 1±3. 1^ab	42. 3±3. 2	81. 1±2. 9^acd	84. 3±2. 9^ab
袖套组Sleeve group	41	45. 1±1. 8	82. 1±3. 0^ac	86. 5±2. 2^ab	42. 1±2. 6	79. 6±3. 2^ac	84. 2±3. 5^ab
非保残组Debridement group	41	45. 0±1. 9	80. 6±4. 1^a	86. 1±1. 3^ab	43. 1±3. 4	78. 0±3. 7^a	84. 0±3. 8^ab
F值		0. 769	1. 427	0. 801	1. 076	2. 502	1. 208
P值		>0. 05	0. 021	>0. 05	>0. 05	0. 016	>0. 05

Table 3 Knee stability comparison of patients by KT-2000 test

组别Groups	例数Number of cases	术前Before operation	术后6个月Six months after operation	术后12个月12 months after operation
悬吊组Suspension group	43	8. 93±2. 33	2. 18±0. 24^acd	1. 99±0. 21^ab
袖套组Sleeve group	41	9. 13±1. 86	2. 25±0. 38^ac	2. 01±0. 32^ab
非保残组Debridement group	41	8. 96±1. 97	2. 32±0. 21^a	2. 01±0. 18^ab
F值		3. 762	5. 483	2. 826
P值		>0. 05	0. 016	>0. 05

Table 4 Comparison of proprioception in the measurement of TTDPM among groups

组别Groups	例数Number of cases	6个月Six months	12个月12 months
悬吊组Suspension group	43	3. 69±0. 31^ab	1. 79±0. 22^abc
袖套组Sleeve group	41	4. 05±0. 42^a	2. 05±0. 51^ac
非保残组Debridement group	41	4. 37±0. 28	2. 28±0. 19^c
F值		2. 912	1. 887
P值		0. 011	0. 018

Table 5 Comparisons of tibial tunnel enlargement between the three groups

组别Groups	例数Number of cases	3个月Three months	6个月Six months	12个月12 months
悬吊组Suspension group	43	0. 15±0. 12^ab	0. 65±0. 18^abc	0. 81±0. 12^abcd
袖套组Sleeve group	41	0. 22±0. 21^a	0. 75±0. 15^ac	0. 92±0. 17^acd
非保残组Debridement group	41	0. 29±0. 27	0. 92±0. 19^c	1. 17±0. 16^cd
F值		3. 276	4. 051	7. 546
P值		0. 041	0. 029	0. 011

Table 6 Comparisons of postoperative MRI signal intensity of grafts

组别Groups	例数Number of cases	3个月Three months	6个月Six months	12个月12 months	F值	P值
悬吊组Suspension group	43	4. 11±0. 46^ab	2. 46±0. 41^abc	1. 25±0. 16^abcd	2. 722	0. 023
袖套组Sleeve group	41	5. 08±0. 42^a	3. 78±0. 35^ac	2. 67±0. 22^acd	2. 462	0. 031
非保残组Debridement group	41	6. 11±0. 51	4. 55±0. 39^c	2. 99±0. 27^cd	3. 435	0. 016
F值		2. 834	1. 867	2. 285
P值		0. 012	0. 017	0. 015

Table 7 Comparisons of grafts SNQ on MRI after surgery

组别Groups	例数Number of cases	3个月Three months	6个月Six months	12个月12 months	F值	P值
悬吊组Suspension group	43	4. 11±0. 46^ab	2. 46±0. 41^abc	1. 25±0. 16^abcd	4. 255	0. 032
袖套组Sleeve group	41	5. 08±0. 42^a	3. 78±0. 35^ac	2. 67±0. 22^acd	4. 151	0. 035
非保残组Debridement group	41	6. 11±0. 51	4. 55±0. 39^c	2. 99±0. 27^cd	5. 546	0. 021
F值		1. 752	1. 583	0. 854
P值		0. 022	0. 028	0. 031

Figure 7 Sagittal MRI of the suspension group three months after operation

Figure 8 Sagittal MRI of the sleeve group three months after operation

Figure 9 Sagittal MRI of the debridement group three months after operation

References 26

［1］	涂俊, 徐斌. 前交叉韧带损伤早期治疗与延期治疗的并发症分析及临床疗效对比［J］. 中国运动医学杂志, 2018, 37（ 7 ）: 558-564.
［2］	刘佳, 高娟, 李嫚, 等. Ligs关节韧带数字体查仪与KT-1000测量前交叉韧带损伤后膝关节前向不稳定的对比研究［J］. 中国运动医学杂志, 2023, 42（ 1 ）: 14-18.
［3］	熊波涵,余洋, 卢晓君, 等. 促进前交叉韧带重建腱骨愈合的研究与进展［J］. 中国组织工程研究, 2023, 27（ 5 ）: 779-786.
［4］	李明, 刘玉强, 高士基, 等. 新型自体半腱肌带状移植物重建术治疗前交叉韧带断裂的早期临床疗效［J］. 中华创伤杂志, 2022,38（ 4 ）: 332-339.
［5］	Meena A, Di Paolo S, Grassi A, et al. No difference in patient reported outcomes, laxity, and failure rate after revision ACL reconstruction with quadriceps tendon compared to hamstring tendon graft: a systematic review and meta-analysis［J］. Knee Surg SportsTraumatolArthrosc,2023, 31（ 8 ）: 3316-3329.
［6］	陈荣进, 顾心怡, 向先祥. 前交叉韧带重建术后移植物成熟度与膝关节功能的相关性研究［J］. 中国修复重建外科杂志, 2021,35（ 6 ）: 704-709.
［7］	岐飞, 刘阳, 孙学斌. 关节镜下前交叉韧带保残重建和非保残重建的研究进展［J］. 新疆医学, 2021,51（ 4 ）: 468-470, 486.
［8］	Petersen W, Tillmann B. Anatomy and function of the anterior cruciate ligament［J］. Orthopade, 2002, 31（ 8 ）: 710-718.
［9］	Śmigielski R, Zdanowicz U, Drwięga M, et al. The anatomy of the anterior cruciate ligament and its relevance to the technique of reconstruction［J］. Bone Joint J, 2016, 98-B（ 8 ）: 1020-1026.
［10］	王江涛, 肇刚, 步建立, 等. 前交叉韧带保残重建术中保残策略病例对照研究［J］. 中国骨伤, 2021,34（ 12 ）: 1095-1102.
［11］	钟国庆, 曾小龙, 谢宇, 等. 全身关节过度活动患者步行时膝关节步态图特征［J/CD］. 中华关节外科杂志（电子版）, 2020,14（ 1 ）: 33-39.
［12］	Fleming JD, Ritzmann R, Centner C. Effect of an anterior cruciate ligament rupture on knee proprioception within 2Yearsafter conservative and operative treatment: a systematic review with metaanalysis［J］. Phys Med, 2022, 52（ 5 ）: 1091-1102.
［13］	王予彬, 李方祥, 张伟佳, 等. MRI和KT-2000对膝关节前交叉韧带损伤早期诊断的临床意义［J］. 中华急诊医学杂志, 2005,14（ 3 ）: 229-231.
［14］	刘鹏鹤, 代志鹏, 赵甲军, 等. 自体血纤维蛋白凝块对前交叉韧带重建术后腱-骨愈合影响的临床研究［J］. 中国修复重建外科杂志, 2017, 31（ 7 ）: 799-804.
［15］	钟名金, 敖英芳. 膝关节前交叉韧带断裂对健侧膝关节软骨影响的实验研究［J］. 中国运动医学杂志, 2020, 39（ 8 ）: 635-639.
［16］	姚望, 潘剑英, 曾春. 保残重建前交叉韧带对膝关节运动学特征的影响［J/CD］. 中华关节外科杂志（电子版）, 2020,14（ 1 ）:24-32.
［17］	Yanagisawa S, Kimura M, Hagiwara K, etal. The relationship between the clinical results and the remnant type following anterior cruciate ligament reconstruction using a hamstring tendon［J/OL］. J OrthopSurg, 2019, 27（ 2 ）: 2309499019837653.DOI:10.1177/2309499019837653.
［18］	Nayak M, Nag HL, Nag TC, et al. Ultrastructural and histological changes in tibial remnant of ruptured anterior cruciate ligament stumps: a transmission electron microscopy and immunochemistrybased observational study［J］. Musculoskelet Surg, 2020, 104（ 1 ）:67-74.
［19］	Samaan MA, Facchetti L, Pedoia V, et al. Cyclops lesions are associated with altered gait patterns and medial knee joint cartilage degeneration at 1 year after ACL-reconstruction［J］. J Orthop Res,2017, 35（ 10 ）: 2275-2281.
［20］	韦钊岚, 韦朝喜, 易伟林, 等. “长袖套”保留残迹前交叉韧带重建术［J］. 中国矫形外科杂志, 2021, 29（ 24 ）: 2261-2264.
［21］	Takazawa Y, Ikeda H, Kawasaki T, et al. ACL reconstruction preserving the ACL remnant achieves good clinical outcomes and can reduce subsequent graft rupture［J/OL］. Orthop J Sports Med, 2013,1（ 4 ）: 2325967113505076. DOI:10.1177/2325967113505076.
［22］	张磊, 谢崇新, 白靖平. 关节镜下保留残端重建前交叉韧带与不保留残端重建的Meta分析［J］. 中国组织工程研究, 2016,20（ 20 ）: 3032-3040.
［23］	Dhillon MS, Bali K, Vasistha RK. Immunohistological evaluation of proprioceptive potential of the residual stump of injured anterior cruciate ligaments （ ACL ）［J］. Int Orthop, 2010, 34（ 5 ）: 737-741.
［24］	廖欣宇, 何璐, 李彦林, 等. 前交叉韧带保残单束解剖重建有利于本体感觉功能的恢复［J］. 中国组织工程研究, 2022,26（ 17 ）:2631-2635.
［25］	Noh JH, Kyung HS, Roh YH, et al. Remnant-preserving and re-tensioning technique to cover the graft in anterior cruciate ligament reconstruction［J］. Knee Surg Sports Traumatol Arthrosc,2017, 25（ 4 ）: 1205-1210.
［26］	李智伟, 刘中冲, 刘兆芹,等. 两种前交叉韧带重建MRI测量移植物位置比较［J］. 中国矫形外科杂志, 2021,29（ 15 ）: 1420-1423.

[1]	Ming Luo, Zhi Yuan, Junjun Fan, Binghui Liao, Haifeng Dang, Tianlei Zheng, Lingxin Bai. Arthroscope-assisted minimally invasive percutaneous plate osteosynthesis in treatment of tibial plateau fractures [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 46-54.
[2]	Youliang Wang, Jipengcuo Du, Zhong Yang, Kai Chen. Efficacy comparison of knee arthroscope-assisted surgery and conventional surgery in treatment of tibial plateau fractures [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 39-45.
[3]	Bin Liu, Yi Wang, Ming Ye, Yongsong Kang, Jianming Chen. Clinical efficacy of “Chinese way” single-row repair for massive rotator cuff injury [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 1-6.
[4]	Peilong Dong, Zhiyun Li, Botao Zhu, Zhaodong Wang, Xiaobo Tang. Comparison of therapeutic effects of two surgical methods for tibial insertion fracture of posterior cruciate ligament [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(06): 800-807.
[5]	Hui Qin, Shan Zhong, Fan Bai, Chenliang Li, Lun Luo. Effect of shock wave intervention on patients with knee arthritis after arthroscopic surgery [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(06): 729-735.
[6]	Xiaomeng Ji, Fan Liu, Xiaobo Tang, Weiwei Bian, Peilong Dong, Zhenlu Liu. Two surgical methods in treatment of rotator cuff tear with adhesive shoulder capsitis [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(05): 561-567.
[7]	Jiemao Su, Yansong Qi, Yongxiang Wang, Baogang Wei, Bingxian Ma, Pengfei Zhang, Xinghua Wei, Yongsheng Xu. Progress in application of arthroscopic surgery in treatment of early- and mid-stage knee osteoarthritis [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(05): 646-652.
[8]	Wei Yu, Yikai Wang, Wenbo Yang, Chunqing Meng, Hong Wang, Wei Huang. Progress of non-united anterior cruciate ligament tibial avulsion fracture [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(04): 532-537.
[9]	Cheng Li, Liang Zhu, Yong Pang, Guochun Zha, Shang Qiu, Wei Sun, Shuo Feng. Lateral suture combined with knotless suture bridge technique for treatment of large L-shaped rotator cuff tears [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(03): 301-306.
[10]	Shuai Lu, Liang Xu, Yao Zhang, Chao Fang, Qichun Zhao. Long-term effect of meniscoplasty on knee osteoarthritis after anterior cruciate ligament reconstruction [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(02): 167-174.
[11]	Zhiman Xiao, Xiqi Zhuang, Yu Gong. Early efficacy of Lasso-loop Gould procedure under arthroscope for treatment of lateral ankle instability [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(02): 280-284.
[12]	Jun Zhang, Qiang Li, Baiyi Meng, Chengyu Li. Arthroscopic release combined with rotator cuff repair for treatment of rotator cuff injury with secondary frozen shoulder [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(01): 1-7.
[13]	Zirong Huang, Yuxin Luo, Wenhan Yang, Xiaohu Chen, Huanyu Xie, Weimin Zhu. Research progress of influence of anterior cruciate ligament reconstruction on knee stability [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 847-854.
[14]	Dian Wang, Shuanghe Liu, Zheng Zeng. Self-controlled cohort study of influence on muscular function changes after shoulder arthroscopy on cervical spine morphology and sagittal parameters [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(05): 371-378.
[15]	Xiaoyu Tang, Kaiwen Deng, Jian Feng, Yiyuan Zou, Xinbo Zheng, Xiaopeng Wang. Comparison of arthroscopic V-Y knot suture and suture bridge technique in repairing medium-size rotator cuff injury [J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2024, 12(02): 107-114.

Please choose a citation manager

Content to export