A simple and effective technique of femoral tunnel bone grafting in revision anterior cruciate ligament reconstruction

Shetty, Gautam M.; Wang, Joon Ho; Chae, In Jung; Han, Seung Beom

doi:10.1007/s00402-007-0430-8

Cited by 9 publications

(7 citation statements)

References 6 publications

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“…During the first stage it is necessary to remove any fixation devices present (e.g. interference screws or transverse fixation systems), clean the bone, removing any fibrous tissue present, and fill the defect left by the fixation devices and the previous tunnel with (preferably autologous) bone graft plugs harvested from the iliac crest or tibial plateau (10)(11)(12). Around 4-6 F. Giron et al To date there are no well-defined landmarks allowing exact localization of the guide wire entry point for creating a femoral tunnel.…”

Section: J Ointsmentioning

confidence: 99%

Femoral tunnel in revision anterior cruciate ligament reconstruction

Giron

Losco

Giannini

et al. 2013

Joints

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The failure rate after anterior cruciate ligament (ACL) reconstruction performed by expert surgeons is estimated to be in the range of 10-15%, and only 60% of patients undergoing this surgery are able to resume sporting activities comparable to those they engaged in prior to the traumatic incident. Incorrect femoral tunnel placement is one of the main causes of failed ACL reconstruction and this must be remembered when undertaking revision surgery. There are various possible errors that can be committed and, to plan revision surgery correctly, it is fundamental to study the position of the existing femoral tunnel(s) both on classic anteroposterior and lateral plain radiographs and on computed tomography scans with frontal, sagittal, and coronal sections, and also using three-dimensional reconstruction. In-depth anatomical knowledge and familiarity with the various possible surgical techniques are also mandatory for a successful surgical outcome. Fig. 5. The dotted line indicates the area under which the femoral insertion point of the new ligament (asterisk) is located.

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Section: J Ointsmentioning

confidence: 99%

Femoral tunnel in revision anterior cruciate ligament reconstruction

Giron

Losco

Giannini

et al. 2013

Joints

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“…A wide variety of void fillers have been adapted for bone tunnel defects, including autograft 22,65,68 and allograft bone, 12,16,70 demineralized bone matrix (DBM), 86 synthetic bone substitutes, 75,79,80 and biologic augments 25,78,86 (Table 2). Autograft sources, including the proximal tibia, 22 iliac crest, 68 and femur, 65 have osteogenic and osteoinductive properties, but they may lack structural support and come at the cost of donor-site morbidity and increased operative time and complexity.…”

Section: Special Considerationsmentioning

confidence: 99%

“…Allograft bone may consist of cancellous chips, structural blocks, or preshaped dowels and offers the advantage of limited donor-site morbidity and ease of use, but it is limited by cost and availability. 12,16,70…”

Section: Special Considerationsmentioning

confidence: 99%

“…A variety of techniques have been described to facilitate morselized graft administration, including use of an osteochondral autologous transfer system tube, 68 arthroscopic cannula, 12,86 modified syringe, 70 or chest tube. 11 These devices permit the morselized graft to be arthroscopically injected into the tunnel under pressure (Figure 6, D and E).…”

Section: Special Considerationsmentioning

confidence: 99%

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Tunnel Management in Revision Anterior Cruciate Ligament Reconstruction: Current Concepts

et al. 2021

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Bone tunnel–related complications are frequently encountered during revision anterior cruciate ligament reconstruction (ACLR). Issues with tunnel positioning, enlargement, containment, and hardware interference may complicate surgery and compromise outcomes. As a result, several strategies have emerged to address these issues and optimize results. However, a systematic, unified approach to tunnel pathology in revision ACLR is lacking. The purpose of this review is to highlight the current state of the literature on bone tunnel complications and, although extensive literature on the subject is lacking, present an updated approach to the evaluation and management of tunnel-related issues in revision ACLR.

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“…Most reported causes of failure are wrong tunnel placement, biological graft failure, tunnel enlargement leading to graft insufficiency, arthrofibrosis, traumatic re-tear [4,5], and other causes related to the primary trauma and surgery [2,6,7].…”

Section: Introductionmentioning

confidence: 99%

Radiological evaluation for conflict of the femoral tunnel entrance area prior to anterior cruciate ligament revision surgery

Tscholl

Biedert

Gal

2013

International Orthopaedics (SICOT)

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Purpose Anterior cruciate ligament (ACL) revision surgery is a demanding procedure and requires meticulous pre-operative clinical and radiological assessment. In clinical practice the position of the femoral tunnel is identified mainly using plain radiographs (XR). Two-dimensional computed tomography (2D-CT) and magnetic resonance imaging (MRI) are not yet routine imaging methods and are only performed in specific clinical indications or in the scientific setting. Several measurement methods describe the femoral tunnel after ACL reconstruction and indicate 'ideal or wrong' placement to the surgeon. The aim of this study is to provide a reliable measurement method to predict potential conflict between the preexisting and the planned femoral tunnel entrance area (FTEA). Methods Ten patients with primary ACL reconstruction served as a reference group to describe our desired FTEA. Their femoral tunnel positioning was measured on XR and 2D-CT according to published measurement methods. These results were compared to the FTEA measured with a new technique on 3-dimensionally reconstructed CT-images (3D-CT) based on intra-operative landmarks. Twenty patients requiring ACL revision surgery underwent identical radiological examination. The mean values of the reference group were compared to each measurement of the patients requiring revision surgery. Results 3D-CT measurements found potential conflicts in nine out of 20 patients, which all proved to be true during arthroscopic revision surgery. Only one of these patients was identified in all XR and 2D-CT measurements. In 12 out of all 30 patients some measurements on XR or 2D-CT could not be recorded.Conclusion 3D-CT reconstruction shows the most accuracy in depicting conflict of the pre-existing and desired femoral tunnel prior to ACL revision surgery. The desired FTEA must be defined for each surgeon and his individual technique. In contrast, precision of conventional measurement techniques on XR and 2D-CT is low and does not qualify for this purpose.

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A simple and effective technique of femoral tunnel bone grafting in revision anterior cruciate ligament reconstruction

Cited by 9 publications

References 6 publications

Femoral tunnel in revision anterior cruciate ligament reconstruction

Femoral tunnel in revision anterior cruciate ligament reconstruction

Tunnel Management in Revision Anterior Cruciate Ligament Reconstruction: Current Concepts

Radiological evaluation for conflict of the femoral tunnel entrance area prior to anterior cruciate ligament revision surgery

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