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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