One-stage revision anterior cruciate ligament reconstruction in cases with excessive tunnel osteolysis. Results of a new technique using impaction bone grafting

Abstract

BackgroundThis level IV study describes a new one-stage procedure for revision ACL reconstruction in cases with extreme tunnel widening. MethodsEight consecutively treated subjects requiring ACL revision and presenting with excessive tunnel widening (87.5% to 250% tunnel enlargement) were included in this study. The graft-tunnel mismatch was resolved in this one-stage revision procedure by the use of custom-made eight to 10 mm cylindrical shaped bone allografts in a press-fit construct with the ACL-graft in combination with the usual fixation devices for ACL-reconstruction. All subjects were evaluated pre-operatively and at a minimum follow-up of one year by the IKDC objective and subjective scores, KOOS, and Tegner activity scale. ResultsMean improvement was 24.8 ± 16.1 on the KOOS evaluation (P-value 0,006) and 38.1 ± 16.8 on the IKDC subjective score (P-value 0,001). The objective IKDC scores improved significantly with an average of one grade (P-value 0,038). Anterior laxity as determined on the KT-1000 arthrometer improved with an average of 3.63 mm compared to the situation before primary reconstruction, and the Pivot-shift test was negative in all but one patient after the revision procedure while positive in all patients before primary reconstruction. ConclusionThis new surgical technique using eight to 10 mm allograft bone cylinders for the management of excessive tunnel enlargement at single stage revision ACL reconstruction delivers excellent results after minimum one year of follow-up. The results of this study have the potential to lower the threshold for one-stage surgery in ACL revision complicated by extreme tunnel widening.