Autologous Bone Graft Versus Silicate-Substituted Calcium Phosphate in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Study With a Minimum Follow-up of 2 Years

Abstract

Purpose: To compare and evaluate knee laxity and functional outcomes between autologous bone graft and silicatesubstituted calcium phosphate (Si-CaP) in the treatment of tunnel defects in 2-stage revision anterior cruciate ligament reconstruction (ACLR). Methods: This prospective, randomized controlled trial was conducted between 2012 and 2015 with a total of 40 patients who underwent 2-stage revision ACLR. The tunnels were filled with autologous iliac crest cancellous bone graft in 20 patients (control group) and with Si-CaP in the other 20 patients (intervention group). After a minimum follow-up period of 2 years, functional outcomes were assessed by KT-1000 arthrometry (side-to-side [STS] difference), the Tegner score, the Lysholm score, and the International Knee Documentation Committee score. Results: A total of 37 patients (follow-up rate, 92.5%) with an average age of 31 years were followed up for 3.4 years (range, 2.2-5.5 years). The KT-1000 measurement did not show any STS difference between the bone graft group (0.9 AE 1.5 mm) and the Si-CaP group (0.7 AE 2.0 mm) (P ¼ .731). One patient in the intervention group (5%) had an STS difference greater than 5 mm. Both groups showed significant improvements in the Tegner score, Lysholm score, and International Knee Documentation Committee score from preoperative assessment to final follow-up (P .002), without any difference between the 2 groups (P ! .396). Complications requiring revision occurred in 4 control patients (22%) and in 2 patients in the intervention group (11%) (P ¼ .660). No complications in relation to Si-CaP were observed. Conclusions: Equivalent knee laxity and clinical function outcomes were noted 3 years after surgery in both groups of patients. Si-CaP bone substitute is therefore a safe alternative to autologous bone graft for 2-stage ACLR. Level of Evidence: Level I, prospective, randomized controlled clinical trial. See commentary on page 186 R upture of the anterior cruciate ligament (ACL) is one of the most common knee injuries, and a marked increase in anterior cruciate ligament reconstructions (ACLRs) has occurred over the past 20 years. 1,2 Because of the rise in operations, the number of revision procedures is also increasing

Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery

“…They published a randomized controlled trial reporting the results of using this technique. 27,28 Si-CaP demonstrates slow biodegradation and excellent resistance to compressive forces. The technique is straightforward, has the advantage of shorter operative time, less blood loss and fewer complications, and avoids donor-site morbidity.…”

Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Silicate-Substituted Calcium Phosphate

“…The technique using the synthetic bone graft substitute Si-CaP described in this article was investigated in a published prospective, randomized controlled trial. 20,21 The tunnels were filled with autologous iliac crest cancellous bone in the control group. A preliminary study was conducted for both histologic and radiologic analyses of the bone graft substitute Si-CaP.…”

“…Analysis of the clinical outcomes after an average follow-up period of 3 years showed significant improvement in sagittal stability and functional scores in both groups, without any difference between the 2 groups. 21 Compared with other methods, the described technique of filling the tunnels Bear in mind that any spilled granulate must be completely removed from the joint. Instruct the patient to limit weight bearing to 20 kg for the first 6 wk after tunnel augmentation.…”

“…The results of the prospective, randomized controlled study showed promising 3-year outcomes with this method. 21 Further studies are needed to describe the long-term outcomes of this technique.…”

Editorial Commentary: Bone Tunnel Grafting for Two-Stage Anterior Cruciate Ligament Revision and the Meaning of Life for an Arthroscopic Surgeon

“…The authors report no conflicts of interest in the authorship and publication of this article. 6 Jan von Recum, Julia Gehm, Thorsten Guehring, Sven Vetter, Philipp von der Linden, Paul-Alfred Grützner, and Marc Schnetzke investigated the performance of silicate-substituted calcium phosphate (Si-CaP) compared with iliac crest autograft in the management of bone tunnels enlargement in 40 patients who were candidates for ACL revision. Aside from determining that comparable clinical results can be achieved by both methods (in terms of knee stability and subjective outcomes at middle-term evaluation), the fact that the use of Si-CaP significantly contributed to reduce operative times, as well as all of the related advantages in terms of risk of infection, and reduced loss of hemoglobin related to bleeding from the harvest site, was a remarkable observation.…”