## 3 Remnant Preservation
Furthermore, remnant preservation during the single-bundle reconstruction was found to prevent tunnel enlargement with the assessment of the tunnel diameter on plain radiographs [14; 15]. However, in regard to double-bundle reconstructions assessed with computed tomography, [PERSON] et al. [16] discounted any protective effect of remnant preservation on the incidence of tunnel enlargement, whereas [PERSON] et al. [17] found remnant preservation to lower  
Figure 1: Reconstruction with preservation of the distal anterior cruciate ligament (ACL) remnant: (a) Tibial guide placed in the middle of a tibial remnant (TR); (b) Drilling of the tibial tunnel through the tibial remnant; (c) ACL graft (G) passing through the distal remnant of a native ACL. the incidence of tunnel enlargement. Additionally, [PERSON] et al. [18] found remnant preservation prevented tunnel enlargement, but only in the anteromedial femoral tunnel. \begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Author** & \begin{tabular}{c} **Year of** \\ **Publication** \\ \end{tabular} & **Study Design** & **Intervention** & \begin{tabular}{c} **Mean** \\ **Follow-Up** \\ \end{tabular} & **Outcomes** \\ \hline \hline [PERSON] et al. [4] & 2017 & Meta-analysis & - & - & No statistically significant difference regarding IKDC grade, IKDC score, Lachman test, Pivot-shift test, range of motion (ROM), and the incidence of the cyclops lesion. & Significantly higher Lysholm score, better arthrometer results and lower tibial tunnel enlargement in remnant-preserving reconstructions. No statistically significant difference regarding IKDC score, complications, Pivot-shift test and Lachman test. \\ \hline [PERSON] et al. [6] & 2018 & Meta-analysis & - & - & No statistically significant difference regarding IKDC score, complications, Pivot-shift test and Lachman test. \\ \hline [PERSON] et al. [7] & 2019 & Meta-analysis & - & - & No statistically significant difference regarding graft maturation, IKDC score, Lachman test and pivot-shift test. \\ \hline [PERSON] et al. [8] & 2012 & Randomized controlled trial & Single-bundle ACLR with a 4-strand allograft. & 25.7 months & No statistically significant difference regarding Irysholm score, IKDC grade, Lachman test, Pivot-shift test, arthrometer results, graft synovial coverage and passive angle reproduction test. \\ \hline [PERSON] et al. [9] & 2000 & Retrospective cohort study & Single-bundle ACLR with a hamstring with a hamstring atograft. & 3.2 years & Significantly better arthrometer results and passive angle reproduction test in favor of remnant-preserving group. No statistically significant difference regarding [PERSON] score and Gilliquist score. \\ \hline [PERSON] et al. [10] & 2008 & \begin{tabular}{c} Case series \\ Comparison of patients with over 20\% of preserved remnant (I) and those with less than 20\% of preserved remnant (II) \\ of preserved remnant (II) \\ \end{tabular} & Single-bundle ACLR with a pedunculated hamstring atograft & 35.1 months & \begin{tabular}{c} Significantly better arthrometer results to detection of passive motion at 30\% and reproduction of passive positioning at 15\% and 30\% in the I group. \\ \end{tabular} \\ \hline [PERSON] et al. [11] & 2007 & Randomized controlled trial & Single-bundle ACLR with a hamstring atograft & 12 months & \
\begin{tabular}{c} The remnant-preserving group had higher SNQ than the remnant-sacrificing group at 2 months of follow-up and lower SNQ at 6 months of follow-up. \\ \end{tabular} \\ \hline [PERSON] et al. [12] & 2016 & Retrospective cohort study & Single-bundle ACLR with a hamstring atograft & 18 months &
\begin{tabular}{c} The remnant-preserving group had higher SNQ than the remnant-sacrificing group at 2-months of follow-up and lower SNQ at 12-18 months of follow-up. \\ \end{tabular} \\ \hline \hline \end{tabular}
\end{table}