University of Colorado School of Medicine.
Arthroscopy. 2023 Sep;39(9):2112-2113. doi: 10.1016/j.arthro.2023.03.021.
Revision anterior cruciate ligament (ACL) reconstruction can be performed in a single surgery, but in some instances, it requires 2 stages to get it right. The most common reasons for staged reconstruction include dilated bone tunnels on the tibial or femoral side (>13 mm), imperfectly placed bone tunnels that cannot be reused but cannot be avoided, and/or the need to combine the revision ACL reconstruction with meniscus and/or cartilage allograft transplantation. In my practice, we use prefabricated bone dowels, sizing up 0.5 to 1 mm relative to the size of the tunnel (after debridement) for both the femoral side and tibial side. The benefits are efficiency and reproducibility, while the challenges include cost and the potential need for multiple dowels if the prefabricated dowels are not long enough. We will occasionally add demineralized bone matrix, particularly on the tibial side, in the event that there is <5 mm of unfilled tunnel using the bone dowel. We wait ∼3 months before proceeding to the second stage using only plain radiographs to assess healing (advanced imaging such as computed tomography scan is not routinely used). We have also begun to push the limits of single-stage revision reconstruction, using dowels in a single setting. No matter what, it is never wrong to perform ACL revision reconstruction as a 2-stage procedure. When performed for the appropriate indications, outcomes tend to be good, regardless of the chosen technique.
前交叉韧带（ACL）的翻修重建可以在一次手术中完成，但在某些情况下，它需要分两期进行才能达到理想效果。分期重建最常见的原因包括胫骨或股骨侧骨隧道扩张（>13 毫米）、无法重新使用且无法避免的骨隧道位置不当、以及/或需要将 ACL 翻修重建与半月板和/或软骨同种异体移植结合起来。在我的实践中，我们使用预制骨栓，相对于隧道（清创后）的大小，股骨侧和胫骨侧都增加 0.5 到 1 毫米。这样做的好处是效率和可重复性，而挑战包括成本和如果预制骨栓不够长可能需要多个骨栓。我们偶尔会在胫骨侧添加脱钙骨基质，特别是在用骨栓填充隧道后<5 毫米的情况下。我们会等待约 3 个月，仅使用普通 X 光片来评估愈合情况（通常不使用 CT 扫描等高级影像学检查），然后再进行第二期手术。我们还开始尝试在单次手术中使用骨栓进行单阶段翻修重建。无论如何，将 ACL 翻修重建作为两期手术来进行永远不会错。只要适应证选择恰当，无论采用何种技术，其结果往往都很好。
