They reported that Si-CaP as a bone-graft substitute for tunnel augmentation showed favorable histologic, radiologic, and intraoperative integration comparable to the autologous iliac bone graft. eCollection 2022 Jun. Patients were divided into the isolated revision ACLR group (n=45) and the revision ACLR group in combination with ALL reconstruction (n=42). But an iliac-crest autograft is comparatively invasive with relatively high donor-site morbidity and the potential for insufficient yield quantities [11, 22]. Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. Cancel anytime. 2002 Richard O'Connor Award paper. Patients who have lost a meniscus or have a significant cartilage defect and have a failed ACL can, in some circumstances, require a meniscus transplant or cartilage replacement surgery. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. - over the top position: Autogenous grafts are considered the gold standard, due to their osteoinductive, osteoconductive, and osteogenic properties. - this technique allows for a more anatomic and precise placement of the femoral tunnel (more reliable posterior placement); Biomaterials 27:50145026, Hing KA, Wilson LF, Buckland T (2007) Comparative performance of three ceramic bone graft substitutes. Two-stage revision anterior cruciate ligament reconstruction, https://doi.org/10.1186/s43019-019-0010-6, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. TECHNIQUE VIDEO. At Mayo Clinic, we also are evaluating surgical techniques for ACL reconstruction, as well as optimal approaches to multiligament knee reconstruction. For example, patients may require bone grafting of prior graft tunnels, and then have the ACL revision in a second stage. Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. doi: 10.1016/j.eats.2022.03.024. Background: Ligament reconstruction is a common procedure in orthopedic surgery. Biazzo A, Manzotti A, Motavalli K, Confalonieri N. J Clin Orthop Trauma. - Surgical Technique: Anterior cruciate ligament (ACL) reconstruction rates have increased over the past 20years to roughly 200,000 per year [1]. 8600 Rockville Pike This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. The use of allograft material negates the issue of donor-site morbidity but carries the potential risk of disease or infection transmission [23, 24]. The .gov means its official. Major reasons to proceed with a two-stage strategy include tunnel-widening or other loss of bone stock, tunnel malposition, arthrofibrosis, active infection, concomitant meniscal deficiency, malalignment, and focal chondral lesions and/or other ligamentous laxity that may require a staged approach [8, 9] (Table1). Sometimes we can perform a biplanar osteotomy to correct both planes of deformity at once. Two-stage revision ACLR should be considered in cases of tunnel lysis, infection, malalignment, meniscal deficiency, or chondral lesions. What other specialized procedures might be performed in conjunction with ACL revision surgery? - this restricts flexion of knee if graft remains intact, or it may elongate graft if the range of motion is restored; At Mayo Clinic, we frequently perform osteotomies to correct both sagittal plane and coronal plane deformity. - consider whether there is an interplay between posterior graft placement and appropriate graft tension; 6 0 obj Arthroscopic Revision of Attenuated Anterior Cruciate Ligament Graft With Enlarged Bone Tunnels Using Injectable Bone Graft Substitute. For a better experience, please enable JavaScript in your browser before proceeding. Clin Orthop Relat Res 474:827835, Van de Pol GJ, Bonar F, Salmon LJ, Roe JP, Pinczewski LA (2018) Supercritical carbon dioxide-sterilized bone allograft in the treatment of tunnel defects in 2-stage revision anterior cruciate ligament reconstruction: a histologic evaluation. Successful revision surgery requires an understanding of the cause of failure, careful preoperative planning, meticulous surgical execution, proper postoperative rehabilitation, and appropriate patient counseling [4]. Am J Sports Med 42:23012310, Noyes FR, Barber-Westin SD, Roberts CS (1994) Use of allografts after failed treatment of rupture of the anterior cruciate ligament. Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? - references: Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel. 2020 Sep;140(9):1211-1219. doi: 10.1007/s00402-020-03421-7. The authors declare that they have no competing interests. At a mean period of 33.9months, there was an improvement in the Lysholm score (77.215.5 vs 72.918.7), IKDC score (69.013.4 vs 69.313.4) and Tegner activity score (4.11.5 vs 4.61.2) for both groups. J Bone Joint Surg Br 89:10511054, Article endstream Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it. Knee-laxity measurements were elevated in the without-revision group, but the difference was not significant. The bone grafting is an opportune time to do an osteotomy to correct the malalignment. A patient with a left knee anterior cruciate ligament tear, torn lateral meniscus and retained hardware from a previous anterior cruciate ligament reconstruction presented for a left knee arthroscopic anterior cruciate ligament repair, open removal of retained hardware and bone grafting of the distal femur and tibial tunnels.Following the arthroscopic anterior cruciate ligament repair, a tibial incision was made through subcutaneous tissue to access the tibial tunnel in order to remove the deep hardware. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. eCollection 2022 Mar. The insertion of an interference screw not only compresses the graft in the tunnel but also leads to an enlargement of the bone tunnel itself [13]. Arthroscopy 21:767, Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Bone Incorporation of Silicate-Substituted Calcium Phosphate in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic and Radiographic Study. In addition, we obtain single leg knee-to-ankle lateral X-rays to assess for any sagittal plane malalignment as well as to look for excessive tibial slope. The primary outcome in 2 studies was graft incorporation (mean follow-up, 8.8 months), whereas the other 5 studies reported clinical outcomes with follow-up mean SD of 4.2 2.1 years. - open technique(which might be required with arthroscopy malfunction). The anterior cruciate ligament (ACL) is a ligament that provides stability to the knee joint. 2021 Oct 12;11(4):e20.00055. - grafts that pass thru femoral tunnels develop more internal pressure at femoral attachment site than those passed over top because of sharp edge of the tunnel; endobj Results: Am J Sports Med 38:19791986, Dye SF (1996) The future of anterior cruciate ligament restoration. - anterior graft placement (relative to normal anatomical insertion of ACL) results in high strain on graft as knee is flexed; Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. . (C) Sagittal magnetic resonance imaging showing insufficiency of the anterior cruciate ligament graft. -allows the femoral attachment point to overlap the anterolateral and posteromedial bundles insertion site registered for member area and forum access. If any of those ligaments were missed in the initial knee surgery, they can be treated in the revision setting. HHS Vulnerability Disclosure, Help To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. MARS Group. Mayo Clinic has vast experience treating posterior cruciate ligament, lateral collateral ligament, posterolateral and posteromedial corner injuries, as well as medial collateral ligament injuries. Knee Surg Sports Traumatol Arthrosc 21:20722080, Magnussen RA, Debieux P, Benjamin B, Lustig S, Demey G, Servien E et al (2012) A CT-based classification of prior ACL femoral tunnel location for planning revision ACL surgery. For a better experience, please enable JavaScript in your browser before proceeding. Arthrosc Tech. The greater the tibial slope, the higher the risk of graft failure as our group found in a 2015 study in American Journal of Sports Medicine. Two-stage revision ACLR typically involves an initial bone-graft procedureto fill the widened or misplaced tunnelsand subsequent time to allow for the bone graft to heal sufficiently before the second stage is undertaken [ 5 ]. This site complies with the HONcode standard for trustworthy health information: verify here. Arthroscopy 33:819827, Diamantopoulos AP, Lorbach O, Paessler HH (2008) Anterior cruciate ligament revision reconstruction: results in 107 patients. The surgeon submitted CPT code 25431 alone. Google Scholar, Mitchell JJ, Chahla J, Dean CS, Cinque M, Matheny LM, LaPrade RF (2017) Outcomes after 1-stage versus 2-stage revision anterior cruciate ligament reconstruction. and transmitted securely. Christensen JJ, et al. 4. This site needs JavaScript to work properly. Terms and Conditions, Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. All rights reserved. Knee 23:830836, MARS Group (2014) Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort. Title: Slide 1 Author: Charles H Brown Created Date: 12/3/2018 11:52:05 AM . ]+yC`6Hd Ql]M 3w7ah;HNdyS*7x-zq^/4%^6eA$m@(,ly}U[N9E(/=iHCL")d6yx]K7!84,q!r~#6mE8dIS69eYn Manage cookies/Do not sell my data we use in the preference centre. Epub 2005 Aug 10. Data Trace is the publisher of Careers. Arthroscopy 34:706713, Hing KA, Revell PA, Smith N, Buckland T (2006) Effect of silicon level on rate, quality and progression of bone healing within silicate-substituted porous hydroxyapatite scaffolds. To date, the literature on revision ACLR surgery has primarily focused on comparing the outcomes to those of primary ACLR. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results.

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