Combined Anterior Cruciate Ligament Tensioned Remnant Suspension Repair and Autograft Reconstruction for Sherman I‐II Anterior Cruciate Ligament Injuries

Abstract

Arthroscopic anterior cruciate ligament reconstruction with tensioned remnant preservation is a simple, reproducible strategy designed to enhance graft biology and stability in appropriately selected patients while maintaining anatomic tunnel accuracy. Prioritized for acute cases with functional remnants (Sherman I‐II), the approach leverages the remnant's “biologic scaffold” and “fluid‐seal” effects to promote graft synovialization, revascularization, and reinnervation, reduce synovial fluid washout into the tunnels, and potentially improve rotational control. When applied under strict indications, this remnant‐preserving, tensioning strategy can achieve functional outcomes comparable to standard anterior cruciate ligament reconstruction while providing additional benefits for graft integration and joint stability.