[Revision anterior cruciate ligament reconstruction with fluoroscopically controlled positioning of the femoral and tibial bone tunnel].

OBJECTIVE

The goal of the fluoroscopically controlled tunnel positioning in anterior cruciate ligament (ACL) revision surgery is the prevention of malpositioning of femoral and tibial tunnel resulting in a reduced risk of rerupture of the ACL graft.

INDICATIONS: Remaining instability of the ACL after performed surgery, either after tunnel filling or as a single-stage surgery.

CONTRAINDICATIONS: Relative: minor instability, contraindications against performing intraoperative x‑rays, advanced osteoarthrosis. Absolute: general contraindications against surgery.

SURGICAL TECHNIQUE: Supine position with tourniquet in place and lateral thigh support. Creation of the portals analogous to ACL surgery. Positioning of the drill wires using a targeting device, first femoral, then tibial. Now use of the C‑arm to fluoroscopically check the wire position using the ACL X‑app; correct it if necessary. If the position is adequate, use the quadrant method according to Bernard and Hertel (femoral) or according to Stäubli (tibial) to drill over to the target size of the drill channel. Subsequently, the transplant is drawn in and fixed. If necessary, add additional peripheral stabilization.

POSTOPERATIVE MANAGEMENT: Knee brace for 6 weeks postoperatively, limited flexion at 90° for 2-3 weeks, partial weight bearing (20 kg) for 2-3 weeks.

RESULTS

In the 51 performed ACL revisions performed, there was a postoperative difference of 1 mm in Rolimeter measurement after 6 months.