Remnant-Tensioning Single-Bundle Anterior Cruciate Ligament Reconstruction Provides Comparable Stability to and Better Graft Vascularity Than Double-Bundle Anterior Cruciate Ligament Reconstruction in Acute or Subacute Injury: A Prospective Randomized Controlled Study Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging
- Authors
- Kim, Jun Ho; Oh, Eunsun; Yoon, Young Cheol; Lee, Do Kyung; Lee, Sung-Sahn; Wang, Joon Ho
- Issue Date
- Jan-2021
- Publisher
- W. B. Saunders Co., Ltd.
- Citation
- Arthroscopy - Journal of Arthroscopic and Related Surgery, v.37, no.1, pp 209 - 221
- Pages
- 13
- Journal Title
- Arthroscopy - Journal of Arthroscopic and Related Surgery
- Volume
- 37
- Number
- 1
- Start Page
- 209
- End Page
- 221
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/19054
- DOI
- 10.1016/j.arthro.2020.08.035
- ISSN
- 0749-8063
1526-3231
- Abstract
- Y Purpose: To compare the clinical, second-look arthroscopic, magnetic resonance imaging (MRI), and dynamic-contrast-enhanced MRI (DCE-MRI) findings between remnant-tensioning single-bundle (RT-SB) and double-bundle (DB) anterior cruciate ligament reconstruction (ACLR). Methods: Sixty-seven patients with acute or subacute anterior cruciate ligament (ACL) injury were randomized to undergo RT-SB or DB ACLR. Twenty-six patients in the RT-SB group and 28 in the DB group were evaluated using stability tests (Lachman test, pivot-shift test, and KT-2000 arthrometer) and multiple clinical scores. One year postoperatively, all 54 patients underwent MRI for evaluation of graft continuity and graft signal/noise quotient and DCE-MRI for the calculation of normalized area under the curve (nAUC) as a marker of graft vascularity. Among them, 41 patients underwent second-look arthroscopy for the evaluation of graft continuity, graft tension, and synovialization. The results were compared between the 2 groups. Results: At the minimum 2-year follow-up (28.7 +/- 6.4 months), the stability tests, clinical scores, second-look arthroscopic findings, and MRI findings were not significantly different between the groups. However, the mean nAUC values on DCE-MRI for the ACL graft were significantly higher in the RT-SB group than those in the DB group in all 3 zones (nAUCproximal, P = .005; nAUC(middle), P = .021; nAUC(distal), P = .027; and nAUC(average), P = .008). Conclusion: For acute or subacute ACL injury, the RT-SB ACLR showed an outcome comparable to that of DB ACLR in terms of knee stability, clinical scores, MRI findings, and second-look arthroscopic findings. Moreover, RT-SB ACLR showed better graft vascularity 1 year postoperatively than DB ACLR using DCE-MRI.
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