No evidence that remnant-preserving anterior cruciate ligament reconstruction ensures better proprioceptive function than a standard single-bundle reconstruction: a systematic review of randomised controlled trials

Importance Injury to the anterior cruciate ligament (ACL) causes significant mechanical instability and unequal functional deficits in patients with similar injury due to loss of proprioception. Therefore, the importance of the ACL remnant has been emphasised; it has the perceived potential to improve postoperative proprioception in knees with ACL reconstruction. However, the current literature shows unproven benefits of doing so, and thus the need for a systematic review. Objective The purpose of this systematic review was to review published randomised control trials (RCTs) to determine whether a remnant-preserving ACL reconstruction offers any proprioceptive benefit over a standard single-bundle ACL reconstruction. Evidence review The PRISMA checklist was used for all aspects of this systematic review. The PubMed, EMBASE, Cochrane and HuGE databases were searched from their inception until 15 June 15 2016 with specific keywords. Trial registry databases were also searched. Findings The initial search yielded 3081 articles. Out of these 2841 did not relate to the research question and were removed. The remaining 240 articles were screened for their abstracts. 178 articles which were either non-clinical studies or not related to ACL remnant preservation and proprioception were excluded. For the remaining 62 studies, full-text articles were studied and 57 were excluded from the study as they were not RCTs or dealt with remnant preservation techniques only in isolation or were non-comparative outcome studies or reviews. That left 5 RCTs. Out of these, 4 did not deal with proprioception as an outcome measure and were excluded. This left only 1 RCT by Hong et al available for the review. Conclusions and relevance At present there is no direct evidence to favour or refute ACL remnant preservation at the time of reconstruction.