Analysis Of The Curative Effect Of Residual And Non Residual Reconstruction On ACL Injury

Background: There is a consensus that arthroscopic reconstruction is the main treatment for anterior cruciate ligament(ACL)injury.The purpose of ACL stump removal is to ensure the clarity of surgical field and anatomic location.Because of the difficulty of preserving the stump reconstruction,it is not easy to expose the bone markers,which may lead to the deviation of bone channel location and increase the incidence of postoperative complications.Whether to use ACL reconstruction with preserved stumps has been controversial.Objective: To evaluate the efficacy of different surgical methods(stump preservation and stump removal)for anterior cruciate ligament(ACL)injury by secondary arthroscopy and knee function score before and after surgery.Methods: from September 2017 to March 2018,40 patients with anterior cruciate ligament reconstruction under arthroscopy were selected from the Department of orthopedics,the First Affiliated Hospital of Guangxi Medical University.The subjects were divided into retention group(stump retention)and non retention group(stump clearance)to reconstruct ACL.Among them,20 patients in the retention group underwent ACL reconstruction with disability preservation,while 20 patients in the non retention group underwent ACL reconstruction without disability preservation.The preoperative and postoperative knee score and arthroscopic examination were evaluated.Results: 1.The Lysholm score and IKDC score of the retention group(stump preservation)and the non-retention group(stump removal)after surgery were significantly improved compared with those before surgery;the knee score of the retention group(stump preservation group)was higher than that of the non-preservation group(stump removal group)at 3 months and 6 months after surgery.There was no significant difference in knee score between the two groups at 12 months after surgery.2.The reconstructed ligaments in the two groups were observed under arthroscopy twice 24 months after operation.According to the evaluation criteria of re-arthroscopy formulated by Ao Yingfang,15 cases were excellent,3 cases were good,2 cases were middle and 0 cases were poor in the retention group(residual removal);7 cases were excellent,5 cases were good,5 cases were middle and 3 cases were poor in the non-retention group(residual removal);the difference between the two groups was statistically significant(Z=2.482,P=0.013).There were also significant differences between the two groups in terms of ligament integrity,ligament tension,ligament synovial membrane coverage and ligament color.Retention of the stump during ACL reconstruction has a significant impact on the outcome of the graft,including ligament integrity,ligament tension,ligament synovial membrane coverage,and ligament color.Conclusion: Retaining the anterior cruciate ligament stump in arthroscopic anterior cruciate ligament reconstruction can obtain relatively better knee stability and clinical effect than clearing the anterior cruciate ligament stump.