Remnant Preservation in Anterior Cruciate Ligament Reconstruction

Background: The rapid degeneration and resorption of the anterior cruciate ligament (ACL) after acute injury pose challenges in reconstruction due to its intra-articular location. Aim of the Work: This study investigates the role of remnant preservation in ACL reconstruction surgery, focusing on its influence on graft revascularization, ligamentization, proprioception, and functional recovery. Patients and Methods: A literature review of studies examining the impacts of remnant preservation on ACL reconstruction outcomes, including second-look arthroscopy findings, clinical results, and complications. Results: Remnant preservation in ACL reconstruction accelerates revascularization and ligamentization, preserves proprioception, and reduces the rate of graft rupture. Techniques involving remnant preservation and re-tensioning show promising results in graft remodeling and synovial coverage. However, remnant preservation may lead to complications included graft impingement, extension loss and cyclops lesions. Conclusion: Remnant preservation plays a crucial role in enhancing native anterior cruciate ligament collagen formation, facilitating better and early ligamentization of the graft. Therefore, the remnant-preserving technique must be recommended in ACL reconstruction surgery to optimize outcomes.