Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Allograft Bone Dowels

Büyükdoğan, Kadir; Laidlaw, Michael S.; Miller, Mark D.

doi:10.1016/j.eats.2017.05.010

Cited by 17 publications

(25 citation statements)

References 24 publications

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“…Numerous studies on alternatives to conventional autologous bone graft for tunnel augmentation have been published in recent years. 10,13 As well as autologous bone, allogeneic bone and synthetic bone graft substitutes can be used. Technical descriptions are available for most procedures, but satisfactory clinical data and histologic results are lacking.…”

Section: Discussionmentioning

confidence: 99%

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Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Silicate-Substituted Calcium Phosphate

Schnetzke

Vetter

Linden

et al. 2019

Arthroscopy Techniques

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Revision surgery after failed primary anterior cruciate ligament reconstruction is technically demanding. In cases in which the tunnels of the primary anterior cruciate ligament reconstruction are widened to greater than 10 mm and/or are incorrectly positioned, a 2-stage procedure enables restoration of bone stock and thus free placement of the tunnels during the revision. The gold standard for tunnel augmentation is an autologous iliac crest cancellous bone graft. However, harvesting the graft is associated with high morbidity. This article describes an alternative method for managing bone deficiencies using the synthetic bone graft substitute silicate-substituted calcium phosphate.

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Section: Discussionmentioning

confidence: 99%

“…An alternative to a 1-stage revision ACLR is a 2-stage procedure with filling of the tunnels placed during primary surgery. 7,12,13 The gold standard for tunnel augmentation is an autologous iliac crest cancellous bone graft. However, harvesting the graft is associated with high morbidity.…”

mentioning

confidence: 99%

Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Silicate-Substituted Calcium Phosphate

Schnetzke

Vetter

Linden

et al. 2019

Arthroscopy Techniques

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“…18,19 Allogeneic bone and synthetic bone substitute materials are alternatives to autologous iliac crest bone graft. 15,[20][21][22] Silicatesubstituted calcium phosphate (Si-CaP) is one bone graft substitute option for tunnel augmentation. 23 Si-CaP is a synthetic porous bone graft substitute with a trabecular structure similar to that of cancellous bone.…”

mentioning

confidence: 99%

Autologous Bone Graft Versus Silicate-Substituted Calcium Phosphate in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Study With a Minimum Follow-up of 2 Years

Recum

Gehm

Guehring³

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose: To compare and evaluate knee laxity and functional outcomes between autologous bone graft and silicatesubstituted calcium phosphate (Si-CaP) in the treatment of tunnel defects in 2-stage revision anterior cruciate ligament reconstruction (ACLR). Methods: This prospective, randomized controlled trial was conducted between 2012 and 2015 with a total of 40 patients who underwent 2-stage revision ACLR. The tunnels were filled with autologous iliac crest cancellous bone graft in 20 patients (control group) and with Si-CaP in the other 20 patients (intervention group). After a minimum follow-up period of 2 years, functional outcomes were assessed by KT-1000 arthrometry (side-to-side [STS] difference), the Tegner score, the Lysholm score, and the International Knee Documentation Committee score. Results: A total of 37 patients (follow-up rate, 92.5%) with an average age of 31 years were followed up for 3.4 years (range, 2.2-5.5 years). The KT-1000 measurement did not show any STS difference between the bone graft group (0.9 AE 1.5 mm) and the Si-CaP group (0.7 AE 2.0 mm) (P ¼ .731). One patient in the intervention group (5%) had an STS difference greater than 5 mm. Both groups showed significant improvements in the Tegner score, Lysholm score, and International Knee Documentation Committee score from preoperative assessment to final follow-up (P .002), without any difference between the 2 groups (P ! .396). Complications requiring revision occurred in 4 control patients (22%) and in 2 patients in the intervention group (11%) (P ¼ .660). No complications in relation to Si-CaP were observed. Conclusions: Equivalent knee laxity and clinical function outcomes were noted 3 years after surgery in both groups of patients. Si-CaP bone substitute is therefore a safe alternative to autologous bone graft for 2-stage ACLR. Level of Evidence: Level I, prospective, randomized controlled clinical trial. See commentary on page 186 R upture of the anterior cruciate ligament (ACL) is one of the most common knee injuries, and a marked increase in anterior cruciate ligament reconstructions (ACLRs) has occurred over the past 20 years. 1,2 Because of the rise in operations, the number of revision procedures is also increasing

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“…An initial surgical procedure is performed to insert the bone graft into the tunnel. 2,3 When the graft is fully integrated with the bone, a second surgical procedure is scheduled to implant a neoligament, with approximately 4 months between surgical procedures.…”

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confidence: 99%

“…Step-by-step Procedure for2-Stage ACL Reconstruction With Extra-articular Stage First Surgical Stage: joint Lavage and Tunnel filling Patient preparation Examination under anesthesia Diagnostic arthroscopy Joint lavage and tunnel debridement Tunnel filling with graft Surgical wound closure Rehabilitation and follow-up between first and second surgical stages Second surgical stage: revision ACL and ALL reconstruction…”

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confidence: 99%

Two-Stage Anterior Cruciate Ligament Reconstruction Revision Surgery for Severe Bone Defects With Anterolateral Ligament Reconstruction Technique

Fernández¹,

Muñiz²,

García³

2020

Arthroscopy Techniques

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Anterior cruciate ligament revision surgery poses a number of specific difficulties. These include the lack of bone mass to enable effective fixation of the reconstruction, morbidity of the donor area when bone autograft is used to fill the tunnels, and absence of the semitendinosus and gracilis homolateral tendons in cases in which they have already been used in the primary surgical procedure. To address all these problems, we describe a 2-stage revision technique that uses bone allograft for tunnel filling and Achilles allograft for ligament reconstruction. In addition, the intervention includes an extra-articular phase in which the anterolateral ligament is reinforced to increase the rotational stability of the knee, thus improving the prognosis of operation.

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Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Allograft Bone Dowels

Cited by 17 publications

References 24 publications

Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Silicate-Substituted Calcium Phosphate

Two-Stage Revision Anterior Cruciate Ligament Reconstruction Using Silicate-Substituted Calcium Phosphate

Autologous Bone Graft Versus Silicate-Substituted Calcium Phosphate in the Treatment of Tunnel Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Study With a Minimum Follow-up of 2 Years

Two-Stage Anterior Cruciate Ligament Reconstruction Revision Surgery for Severe Bone Defects With Anterolateral Ligament Reconstruction Technique

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