Clinical effects of different remnant‐preserving versus standard nonpreserving techniques in anterior cruciate ligament reconstruction: A systematic review and meta‐analysis
Bibliographic record
Abstract
PURPOSE: In anterior cruciate ligament reconstruction (ACLR), the clinical benefits and limitations of nonpreserving versus different remnant-preserving ACLR are not well defined. There is also a lack of systematic analysis of ACL remnant length. METHODS: Database searches were performed in PubMed, Embase, Web of Science and Cochrane CENTRAL from inception to 25 April 2025. Risk of bias was assessed using the Cochrane Collaboration's tool and the Newcastle-Ottawa scale (NOS) critical appraisal tools. Certainty of evidence was evaluated using the grading of recommendations assessment, development and evaluation (GRADE) framework. The reported outcomes used for analysis included stability-related indicators, functional scores, synovial coverage and complications. Subgroup analyses were performed across three remnant-preserving surgical approaches: Augmentation, tension and sparing. Meta-regression and network meta-analyses were performed to investigate whether improved outcomes were associated with remnant length. Sensitivity analysis was used to assess the robustness of the results. RESULTS: Our analysis included 36 articles. For stability, the remnant-preserving (R) group showed improved outcomes compared to the nonremnant (NR) group in the Lachman test (weighted mean difference [WMD] = 1.61, p = 0.0003), Side-to-side anterior laxity (SSD, WMD = -0.27, p = 0.03) and Pivot shift test (WMD = 1.34, p = 0.03), with the highest improvement observed in the Sparing subgroup. For functional scoring, the R group exhibited significantly higher Lysholm knee scoring scale scores (WMD = 1.52, p = 0.01), Tegner athletic ability evaluation score (WMD = 0.40, p < 0.00001), and International Knee Documentation Committee (IKDC) subjective scores (WMD = 1.00, p = 0.001), with the Tension subgroup showing the highest overall improvement. The R group also achieved better synovial coverage (odds ratio [OR] = 2.00, p = 0.0004) and lower failure (OR = 0.48, p = 0.002), particularly in the augmentation subgroup. Meta-regression indicated a correlation between increased graft length and reduced SSD (β = -1.33, p = 0.01), improved IKDC scores (β = 20.03, p = 0.01), and fewer complications (β = -2.61, p = 0.01). Network meta-analysis indicated a 75% remnant preservation ratio minimised SSD alongside enhanced functional scores. CONCLUSION: Remnant-preserving ACLR showed improvements in stability and synovial coverage. However, in terms of clinical outcomes, the improvement in functional recovery has not reached a significant level. Sparing exceled in improving stability, while augmentation effectively reduced failure and tension favoured function. Increasing remnant preservation length significantly improved stability and function concomitantly reducing complications. CLINICAL TRIALS: CRD42024550746. LEVEL OF EVIDENCE: Level III.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.029 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.043 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".