Anterior Cruciate Ligament preservation during reconstructive surgery: Does the extra surgical effort improve patient outcomes at one year?

Abstract Background The aim of this prospective cohort study was to compare patient-reported and clinical outcomes at one year post-operatively in patients who had a standard quadruple stranded hamstring tendon anterior cruciate ligament (ACL) reconstruction to those who had ACL tissue preservation with a double semitendinosus reconstruction. Materials and Methods Forty-five patients were selected for ACL preservation surgery (ACL Preserved group) and were matched by age, sex and injury acuity to 45 patients who had a standard reconstruction (ACL Reconstructed group). The primary outcome was the validated ACL-QOL score. Secondary outcomes included the IKDC Subjective and Objective assessments, clinical and instrumented laxity testing, and Tegner Activity Level. All outcomes were measured at baseline and at a minimum of one year post-operatively, by an independent qualified assessor. Results The two patient groups were similar for all baseline characteristics except for a larger number of meniscal pathology in the ACL Reconstructed group. Both groups had statistically significant and clinically important improvement from baseline to one year. The ACL Preserved group showed better results for all outcomes. The ACL-QOL change score from baseline was 8.6 points (p=0.04) higher for the ACL Preserved compared to the ACL Reconstructed group. KT-2000 measurements showed a statistically significant side-to-side difference between groups. The IKDC Objective assessment reported 87% of patients with normal/nearly normal knees in the ACL Preserved group compared to 80% in the ACL Reconstructed group. Conclusions In patients where it is possible and feasible to preserve ACL tissue, this study suggests that the more technically demanding procedure involving ACL preservation during reconstructive surgery is worth the extra effort. The procedure provides a consistent and measurable benefit in terms of knee stability and quality of life at one year post-operative, compared to a standard hamstring reconstruction. Level of evidence Therapeutic, prospective cohort study; Level II.