Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix

Chahla, Jorge; Dean, Chase S.; Cram, Tyler R.; Civitarese, David; O’Brien, Luke; Moulton, Samuel G.; LaPrade, Robert F.

doi:10.1016/j.eats.2015.10.021

Cited by 41 publications

(60 citation statements)

References 14 publications

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“…The two-stage revision ACL reconstruction has been described in detail elsewhere. 6,7,11,16 During the first stage, all hardware interfering with tunnel-placement were removed and old bone tunnels were drilled out and filled with allograft bone dowels. Treatment to any concurrent meniscal or chondral injury was left to the discretion of the treating physician.…”

Section: Surgical Techniquementioning

confidence: 99%

The Occurrence of Meniscal and Chondral Injury in Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Consecutive Case Series

et al. 2019

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Two-stage revision anterior cruciate ligament (ACL) reconstruction is an effective way to revise suboptimal tunnel-placement allowing for proper graft fixation. However, prolonged increased laxity of the knee may increase the risk of meniscal or chondral injury. It was hypothesized that no additional meniscal or chondral lesions occur in between the two stages of the two-stage revision ACL reconstruction. In this retrospective study, 42 patients undergoing a two-stage revision ACL reconstruction were included. Surgical notes for both stages were screened for meniscal and chondral status, interventions to any concurrent injury, surgery dates, along with basic patient characteristics. In 4 of the 42 patients, a new meniscal tear occurred in between the two stages, of which three required partial meniscectomy during the second stage of the ACL revision. One patient experienced a new small degenerative tear that did not require intervention. Two out of the four menisci that were repaired during the first stage had failed and required partial meniscectomy. No significant difference was found in the time between the two stages with respect to the occurrence of meniscal tears. No significant differences in chondral status were found. In conclusion, approximately 10% of patients developed a new meniscal tear and no difference in macroscopic chondral injury was observed between the first and second stages.

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Section: Surgical Techniquementioning

confidence: 99%

The Occurrence of Meniscal and Chondral Injury in Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Consecutive Case Series

et al. 2019

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“…13,14 A 2-stage procedure with filling of the tunnels is recommended for the first revision for tunnel enlargements of 10 to 15 mm and/or potential tunnel confluence. 13,[15][16][17] The tunnels are routinely filled with autologous iliac crest cancellous bone. 17 Harvesting autologous iliac crest cancellous bone is associated with a high morbidity rate.…”

mentioning

confidence: 99%

“…18,19 Allogeneic bone and synthetic bone substitute materials are alternatives to autologous iliac crest bone graft. 15,[20][21][22] Silicatesubstituted calcium phosphate (Si-CaP) is one bone graft substitute option for tunnel augmentation. 23 Si-CaP is a synthetic porous bone graft substitute with a trabecular structure similar to that of cancellous bone.…”

mentioning

confidence: 99%

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

Recum

Gehm

Guehring³

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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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

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“…An initial surgical procedure is performed to insert the bone graft into the tunnel. 2,3 When the graft is fully integrated with the bone, a second surgical procedure is scheduled to implant a neoligament, with approximately 4 months between surgical procedures.…”

mentioning

confidence: 99%

Two-Stage Anterior Cruciate Ligament Reconstruction Revision Surgery for Severe Bone Defects With Anterolateral Ligament Reconstruction Technique

Fernández¹,

Muñiz²,

García³

2020

Arthroscopy Techniques

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Anterior cruciate ligament revision surgery poses a number of specific difficulties. These include the lack of bone mass to enable effective fixation of the reconstruction, morbidity of the donor area when bone autograft is used to fill the tunnels, and absence of the semitendinosus and gracilis homolateral tendons in cases in which they have already been used in the primary surgical procedure. To address all these problems, we describe a 2-stage revision technique that uses bone allograft for tunnel filling and Achilles allograft for ligament reconstruction. In addition, the intervention includes an extra-articular phase in which the anterolateral ligament is reinforced to increase the rotational stability of the knee, thus improving the prognosis of operation.

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Two-Stage Revision Anterior Cruciate Ligament Reconstruction: Bone Grafting Technique Using an Allograft Bone Matrix

Cited by 41 publications

References 14 publications

The Occurrence of Meniscal and Chondral Injury in Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Consecutive Case Series

The Occurrence of Meniscal and Chondral Injury in Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Consecutive Case Series

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

Two-Stage Anterior Cruciate Ligament Reconstruction Revision Surgery for Severe Bone Defects With Anterolateral Ligament Reconstruction Technique

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