Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting

Prall, Wolf Christian; Kusmenkov, Thomas; Fürmetz, Julian; Haasters, Florian; Mayr, Hermann O.; Böcker, Wolfgang; Grote, Stefan

doi:10.1016/j.injury.2018.12.020

Cited by 9 publications

(17 citation statements)

References 45 publications

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“…These findings indicate that it is not a single but rather a combination of conditions that underly the indication for a two-staged procedure in the majority of patients. The association of ligament malposition and tunnel widening is a phenomenon also observed in other studies [16,18,22,33]. Concerning the extend of tunnel malpositioning and the distribution of tunnel widenings, no differences were noted between the two groups (Figs.…”

Section: Discussionsupporting

confidence: 83%

“…According to the values of the present study, von Recum et al revealed mean values of 406-420 HU after grafting autologous cancellous bone derived from the iliac crest [18]. The grafting of autologous cancellous bone harvested by a reamer-irrigator-aspirator at the ipsilateral femur averaged 574.0 HU for the femur and 516.7 HU for the tibia [22]. Furthermore, void filling utilizing silicate-substituted calcium phosphate resulted in mean density values as high as 1095 and 1121 HU [18].…”

Section: Discussionsupporting

confidence: 51%

“…CT analyses of the preexisting tunnels with regard to placement and maximum width were conducted in all cases as described before [22]. The CT scan datasets were exported to OsiriX DICOM Viewer V8.0 and processed into 3D surface models.…”

Section: Ct Analyses Of the Preexisting Tunnelsmentioning

confidence: 99%

“…The distance between the actual and the ideal aperture centre was determined as percentage point values. Tunnel positioning was considered anatomical when the centre of the aperture was inside a 10 percentage point margin around the ideal insertion point [22,26]. The maximum femoral and tibial tunnel diameters were determined measuring the largest width at right angles to the tunnel axis on the sagittal, coronal or axial planes.…”

Section: Ct Analyses Of the Preexisting Tunnelsmentioning

confidence: 99%

“…The operations were conducted with the leg being positioned in a mobile leg holder. The bone grafting procedure was conducted as published previously [22]. Exsanguination was generated and a tourniquet was inflated to 250 mmHg.…”

Section: Bone Grafting Proceduresmentioning

confidence: 99%

See 4 more Smart Citations

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

Prall

Kusmenkov

Schmidt

et al. 2020

Arch Orthop Trauma Surg

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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.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 51%

Section: Ct Analyses Of the Preexisting Tunnelsmentioning

confidence: 99%

Section: Ct Analyses Of the Preexisting Tunnelsmentioning

confidence: 99%

Section: Bone Grafting Proceduresmentioning

confidence: 99%

See 3 more Smart Citations

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

Prall

Kusmenkov

Schmidt

et al. 2020

Arch Orthop Trauma Surg

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Editorial Commentary: Bone Tunnel Grafting for Two-Stage Anterior Cruciate Ligament Revision and the Meaning of Life for an Arthroscopic Surgeon

Kon

Matteo

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Accurate bone tunnel filling in a 2-staged anterior cruciate ligament revision is indubitably fundamental for a successful outcome. Bone autograft is commonly employed and it is usually harvested from the iliac crest: this requires longer surgical time, and donor-site morbidity following bone harvest is a well-known problem. Therefore, strategies to minimize or abolish it have been attempted: the use of allografts may seem promising, but their use is associated with high costs and strict regulatory limitations. Bony substitutes instead represent a new and potentially effective solution: they could help surgeons to fill bone tunnels in an easier and faster way that elicits satisfactory lamellar bone formation within the tunnels, and their use is associated with fewer postoperative complications, such as pain and local hematoma. Evidence from literature suggests that this approach could provide significant advantages over traditional autograft harvesting, with comparable outcomes in terms of bone formation and integration, allowing a correct tunnel placement during revision surgery.

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Editorial Commentary: Revision of Failed Double-Bundle Anterior Cruciate Ligament Reconstruction

Mayr

Prall

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Double-bundle (DB) reconstruction of the anterior cruciate ligament was favored for several years. However, recent studies increasingly show that this technique does not provide a clear advantage over the less-invasive singlebundle technique. Unfortunately, the graft fails relatively often after ACL reconstruction. Postoperative communication of the bone tunnels through bone tunnel widening is possible. Since 2 drill channels are created in the DB technique, femoral as well as tibial, it is assumed that this technique may cause problems during revision. So, in part, revision may require a 2-step procedure with bone graft filling of the tunnels as the first step. It is important that surgeons with experience using DB publish their revision strategies and experiences.

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Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting

Cited by 9 publications

References 45 publications

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

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

Editorial Commentary: Bone Tunnel Grafting for Two-Stage Anterior Cruciate Ligament Revision and the Meaning of Life for an Arthroscopic Surgeon

Editorial Commentary: Revision of Failed Double-Bundle Anterior Cruciate Ligament Reconstruction

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