Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery

Abstract

Objectives Patients with recurrent instability after anterior cruciate ligament (ACL) reconstruction often present with enlarged or misplaced tunnels and bone grafting is required prior to the actual revision reconstruction. Autologous bone grafting features limited quantity and donor site morbidity. These problems may be eliminated utilizing cancellous bone allografts, but their efficiency and reliability have not been investigated systematically. The aim of the present study was to compare tunnel filling rates attained by utilizing either allogenic or autologous cancellous bone grafts. Materials and methods A total of 103 consecutive patients were enrolled retrospectively. All patients suffered from recurrent instability and underwent either allogenic or autologous cancellous bone grafting. Computed tomography (CT) was carried out before and after the bone grafting procedure. Based on preoperative CT scans, positioning and maximum diameter of the femoral and tibial tunnels were determined. Tunnel filling rates were calculated as a ratio of pre-and postoperative tunnel volumes. Primary outcome was the tibial tunnel filling rate. Femoral filling rates and density of the grafted bone were assessed secondarily. Results Preoperative CT scans revealed no significant differences between the two groups regarding distribution of misplacement and widening of the femoral or tibial tunnel. Postoperative CT scans were conducted after an interval of 5.2 months. Tunnel filling rates of 74.5% (± 14.3) femoral and 85.3% (± 10.3) tibial were achieved in the allogenic compared to 74.3% (± 15.9) femoral and 84.9% (± 9.4) tibial in the autologous group. With p values of 0.85 at the femur and 0.83 at the tibia, there were no significant differences between the groups. The density of the grafted bone revealed significantly higher values in the allogenic group. Conclusions Utilizing cancellous bone allografts in two-staged revision ACL surgery provides for sufficient and reproducible filling of enlarged or misplaced tunnels. The filling rates are comparable to those achieved with autologous bone grafting. Advantages of allografts are the unrestricted quantity and the absence of any harvesting procedure.

Primary stability of single-stage revision reconstruction of the anterior cruciate ligament in case of failure of dynamic intraligamentary stabilization depends on implant position during ACL repair

“…Therefore, when performing ACL repair using the DIS technique the distance between the cylindrical implant site and the tibial joint line is decisive in the revision surgery setting: If a distance of 20 mm or more is left between the monobloc and the tibial joint line, an anatomic bone tunnel can be created in revision ACL-R without concerns regarding confluent tibial tunnels or a lack of bone stock for graft fixation in the subchondral portion of the tunnel. If the distance between the DIS implant and the joint line is lower than 20 mm, a two-stage revision surgery with bone grafting of the defect should be considered, corresponding to the established procedure in revision ACL-R in case of recurrent instability after previous ACL-R [ 13 ].…”

“…The surgical treatment of recurrent ACL instability is a challenging procedure: the history of previous ACL reconstruction (ACL-R) including a previously harvested tendon as well as the position of an eventual widened bony tunnel can compromise the graft fixation [11][12][13]. In both primary and revision ACL-R, the majority of orthopedic surgeons' rely on a hybrid fixation of the ACL graft at the tibial side.…”

“…The diameter of the tibial tunnel and the IFS are chosen depending on the diameter of the tendon graft, which is usually between 6 and 9 mm. In revision surgery of the ACL, a two-stage procedure is often necessary in order to restore the bony anatomy prior to performing a revision reconstruction of the ACL with anatomic bone tunnel placement [ 11 , 13 ].…”

Allografts: expanding the surgeon’s armamentarium

“…Cancellous bone allograft has been described in a wide range of settings and has been recently used for patients with recurrent instability after anterior cruciate ligament (ACL) reconstruction (Kodach et al 2008). A recent study by Prall et al investigated the use of PAA treated freeze-dried cancellous bone chips and compared its use with autologous cancellous bone grafting (Prall et al 2020). In the study, it is reported that cancellous bone allograft was used for filling of enlarged or misplaced tunnels in two-staged revision ACL surgery.…”

Bewusst unterbewusst – Neuromuskuläres Training nach VKB-Ruptur

“…Für eine erneute VKB Plastik ist es je nach Weitung und Lage der Bohrkanäle in einigen Fällen notwendig diese in einer ersten OP mit Knochenmaterial aus dem Beckenkamm aufzufüllen. Erst nach 4–6 Monaten kann dann die wiederholte VKB-Rekonstruktion mit einem neuen Transplantat erfolgen 14 , 24 , 35 . Der lange Rehabilitationszeitraum ist bei Patient*innen mit einer großen psychischen Belastung verbunden.…”