Two-Stage Revision ACL Reconstruction with Arthroscopic Tunnel Bone Grafting.

BACKGROUND

Anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and due to the increased number of primary reconstructions being performed, the number of revision ACL reconstructions is also increasing.

INDICATIONS: Two-stage revision ACL reconstruction has lower failure rates compared to 1-stage and is indicated when significant tunnel expansion has occurred or malpositioned tunnels prohibit an adequate reconstruction. In this presentation, 2-stage revision ACL reconstruction was performed with an arthroscopic bone grafting technique of both the femoral and tibial tunnels secondary to tunnel osteolysis.

TECHNIQUE DESCRIPTION: Standard diagnostic arthroscopy is performed, and any chondral or meniscal pathology is addressed. The remnant ACL graft and all hardware are removed. The tunnels are debrided thoroughly. Using a modified syringe, the tunnels are packed with a mixture of cancellous bone chips and cortical fibers that have been hydrated with whole blood and platelet-rich plasma (PRP). The patient is placed into a brace postoperatively, and a computed tomography (CT) is obtained approximately 4 to 6 months postoperatively to assess for bone healing. Revision ACL reconstruction is performed once indicated with standard rehabilitation and return to play protocol.

RESULTS

Both 1-stage and 2-stage revision ACL reconstructions have been demonstrated to have significant improvement in outcomes scores preoperatively to postoperatively. However, 2-stage has lower failure rates compared to single-stage and has a high return to level of play.

DISCUSSION/

CONCLUSION

Revision ACL reconstruction is becoming more commonly performed, and 2-stage revision is frequently required due to multiple factors. In this video, we demonstrate bone grafting for revision ACL reconstruction for tunnel osteolysis.

PATIENT CONSENT DISCLOSURE STATEMENT: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.