Abstract

With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. When performing a revision reconstruction, the surgeon decides between a single-stage or a two-stage revision. Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active infection, and concomitant knee pathology (e.g., malalignment, other ligamentous injuries, meniscal or chondral lesions). Among these potential scenarios requiring a two-stage revision, tunnel-widening is the most common cause; the first stage involves graft removal, tunnel curettage, and bone grafting, followed by revision ACL reconstruction in the second stage. The purpose of this article is to review the preoperative planning, surgical considerations, rehabilitation, and outcomes of two-stage revision ACL reconstructions and summarize the recent literature outlining treatment results.

Highlights

  • Anterior cruciate ligament (ACL) reconstruction rates have increased over the past 20 years to roughly 200,000 per year [1]

  • Two-stage revision ACL reconstruction (ACLR) typically involves an initial bone-graft procedure—to fill the widened or misplaced tunnels—and subsequent time to allow for the bone graft to heal sufficiently before the second stage is undertaken [5]

  • Additional procedure Numerous studies have reported that additional procedures (e.g., extra-articular tenodesis, anatomical anterolateral ligament (ALL) reconstruction) could be a meaningful option in cases of revision ACLR to improved rotatory stability which is associated with re-injury

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Summary

Introduction

Anterior cruciate ligament (ACL) reconstruction rates have increased over the past 20 years to roughly 200,000 per year [1]. As this number has continued to increase, the incidence of revision ACL reconstruction (ACLR) has grown to a rate of between 4.1 and 13.3% of all primary ACLRs performed [2]. The goal of revision ACLR is to improve knee stability and activity levels, but the outcomes are reported to be inferior to those of primary ACLR [3]. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. A relatively small but challenging subset of patients requires two-stage revision ACLR.

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