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

Abstract

Introduction The object of this study was to evaluate the primary stability of tibial interference screw (IFS) fixation in single-stage revision surgery of the anterior cruciate ligament (ACL) in the case of recurrent instability after ACL repair with dynamic intraligamentary stabilization (DIS), dependent on the implant position during DIS. Materials and methods Tibial aperture fixation in ACL reconstruction (ACL-R) was performed in a porcine knee model using an IFS. Native ACL-R was performed in the control group (n = 15). In the intervention groups DIS and subsequent implant removal were performed prior to single-stage revision ACL-R. A distance of 20 mm in group R-DIS1 (n = 15) and 5 mm in group R-DIS2 (n = 15) was left between the joint line and the implant during DIS. Specimens were mounted in a material-testing machine and load-to-failure was applied in a worst-case-scenario. Results Load to failure was 454 ± 111 N in the R-DIS1 group, 154 ± 71 N in the R-DIS2 group and 405 ± 105 N in the primary ACL-R group. Load-to-failure, stiffness and elongation of the group R-DIS2 were significantly inferior in comparison to R-DIS1 and ACL-R respectively (p < 0.001). No significant difference was found between load-to-failure, stiffness and elongation of R-DIS1 and the control group. Conclusion Primary stability of tibial aperture fixation in single-stage revision ACL-R in case of recurrent instability after DIS depends on monobloc position during ACL repair. Primary stability is comparable to aperture fixation in primary ACL-R, if a bone stock of 20 mm is left between the monobloc and the tibial joint line during the initial procedure.

Comparable Instrumented Knee Joint Laxity and Patient-Reported Outcomes After ACL Repair With Dynamic Intraligamentary Stabilization or ACL Reconstruction: 5-Year Results of a Randomized Controlled Trial

“…However, it has been shown that primary stability of tibial graft fixation in the case of failure of ACL repair with DIS is comparable with that of aperture fixation in primary ACL reconstruction if a bone stock of 20 mm is left between the DIS implant and the tibial joint line during the initial procedure. 16 …”

“…However, it has been shown that primary stability of tibial graft fixation in the case of failure of ACL repair with DIS is comparable with that of aperture fixation in primary ACL reconstruction if a bone stock of 20 mm is left between the DIS implant and the tibial joint line during the initial procedure. 16 In contrast, each ACL revision surgery in the ACL reconstruction group consisted of staged revision because of tibial tunnel widening .10 mm according to our revision standard. 41 However, when assuming a threshold of 15 mm, all the revision procedures would have been single-staged.…”

Graft failure and revision rate after ACL repair with dynamic intraligamentary stabilization. One‐year results of a prospective case series of 155 patients

“…However, to successfully perform a revision after failed DIS, care should be taken with primary implantation. Glasbrenner et al showed that, in a porcine knee model, when a bone bridge of about 20 mm is left between the monoblock and tibial joint line knee stability of a single stage revision is comparable to that of a primary ACL reconstruction [ 32 ].…”