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M. OCHI, A. NAKAMAE, N. ADACHI
152
SECOND-LOOK
ARTHROSCOPIC
EVALUATION AFTER ACL
RECONSTRUCTION
Several studies have assessed graft conditions
after ACL reconstruction by direct observation
with use of second-look arthroscopy. Second-
look arthroscopy after ACL reconstruction is
one of the most reliable types of examination to
provide valuable prognostic information on the
graft, such as synovial coverage, tension, and
damage of the graft, as well as on synovial
coverage of the space between the opening of
the femoral bone tunnel and the graft. Second-
look arthroscopy shows that graft loosening or
partial tear can occur even in clinically
successful knees. Moreover, it is known that
synovial coverage of the grafts differs
substantially between cases. Good synovial
coverage over the graft may accelerate
revascularization and cellular proliferation of
the grafted tendon. In addition, sufficient
synovial coverage may improve proprioceptive
ability of the knee after ACL reconstruction.
Recently, we reported on the clinical outcomes
and second-look arthroscopic findings of
216 patients who underwent ACL re
construction (central anatomic single- or
double-bundle ACL reconstruction) or ACL
augmentation [10]. In 94 of the 216 patients,
knee joint proprioceptive function was
evaluated using the threshold to detect passive
motion test (TTDPM) before and 12 months
after surgery. Second-look arthroscopy showed
significantly better synovial coverage over the
graft in the ACL augmentation group (good,
82%; fair, 14%; poor, 4%) than in the other
two groups. The mean side-to-side difference
of anterior displacement of the tibia measured
with a KT-2000 arthrometer was 0.4mm in the
augmentation group, 0.9mm in the double-
bundle group, and 1.3mm in the single-bundle
group. Hence, the result differed significantly
between the augmentation and single-bundle
groups. No significant difference in the
Lysholm knee score or pivot-shift test was
observed between the three groups. In patients
with good synovial coverage, three of the four
measurements used revealed significant
improvement in knee joint proprioceptive
ability. In conclusion, patients in the ACL
augmentation group exhibited better knee
stability than those in the standard single-
bundle reconstruction group and better synovial
coverage over the graft upon second-look
arthroscopy than those in the standard anatomic
single- and double-bundle reconstruction
groups. Improvement in knee proprioceptive
ability was observed in patients with good
Fig. 2:
Posterolateral (
PL
) bundle- preserving ACL
augmentation for anteromedial (
AM
) bundle
rupture (black arrow, grafted tendon; white arrow,
preserved PL bundle).
Fig. 3:
Double-bundle reconstruction with the
remnant-preserving technique (short white arrow,
grafted PL bundle; long white arrow, grafted AM
bundle; black arrow, preserved ACL remnant).