Failed ACL with Tunnel Enlargement: How I Bone Graft & Stage It
[Pages:31]Failed ACL with Tunnel Enlargement: How I Bone Graft & Stage It
Charles H. Brown Jr.,MD Director Abu Dhabi, United Arab Emirates
Our Experience: 2014 - 2018
? 183 revisions ? 129 patients required 1-stage revision ? 54 patients required 2-stage revision ? 49 (27%) patients required root repair ? 93 (51% underwent extraarticular reconstruction ? Technical error (non-anatomic tunnel placement)
the most common cause of failure
? Failure to recognize and treat associated
ligamentous laxities and malalignment second most common cause of failure
2-stage revision ACL reconstruction
? 2-stage revision ACLR allows for
uncompromised placement of the new ACL bone tunnels
? 2-stage revision ACLR allows for good
bone stock for fixation of the revision ACL graft
? 2-stage revision ACLR provides the optimal
biological environment for healing of the new ACL graft
Indications for 2-stage revision ACLR
? Bone tunnel enlargement or expansion
Indications for 2-stage revision ACLR
? Overlapping bone tunnels
2-stage revision ACLR: bone grafting
? Bone grafting can be performed using iliac
crest autograft or allograft bone
? Autograft bone has the presence of
osteoblasts which provide direct osteogenesis
? Autograft bone also has growth factors which
premits osteoinduction
? Allograft bone lacks osteoblasts and growth
factors
? As a result, allograft bone takes longer to
incorporate
Anterior iliac crest bone graft
? Best option in a young patient who wants
to proceed with the 2-stage as soon as possible
Limitations of Iliac Crest Bone Graft
? Limitation on the amount of bone
available
? Postoperative pain ? Donor site morbidity
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