Kelly Michaela, Schuck Jennifer, Gardner Andrew, Newman Justin
Advanced Orthopedics Division, Orthopedic Centers of Colorado, Aurora, Colorado, U.S.A.
Arthrosc Tech. 2024 Sep 21;14(2):103236. doi: 10.1016/j.eats.2024.103236. eCollection 2025 Feb.
Autologous or allograft bone grafting is commonly used for bone restoration in the setting of revision anterior cruciate ligament (ACL) reconstruction owing to bone loss or malpositioned or osteolytic tunnels. For significant defects, staged procedures with initial bone grafting to the femoral and/or tibial tunnels is occasionally required. In this setting, allograft shows variable rates and quality of healing and can incur increased expense. Historical techniques of autograft harvest are associated with limited graft volume and donor-site morbidity. Our technique of retrograde femoral autograft harvest shows excellent volume and quality of graft; minimal morbidity; operative expediency; and rapid, quality tunnel filling to facilitate an anatomic second-stage revision ACL reconstruction. Intramedullary bone graft harvest using a Reamer-Irrigator-Aspirator has shown efficacy for typical use in the setting of nonunion, particularly among orthopaedic trauma surgeons. Advantages of using the RIA 2 (Reamer-Irrigator-Aspirator) system (DePuy Synthes) for autologous bone graft harvest include lower donor-site morbidity, greater bone graft volume, decrease in number and size of incision sites, shorter harvest time, and efficacious healing. The goal of this procedure is to obtain an adequate amount of autologous bone graft using a minimally invasive device, RIA 2, safely and efficiently for a 2-stage revision ACL reconstruction.
由于骨丢失、隧道位置不当或溶骨，自体或同种异体骨移植常用于翻修前交叉韧带（ACL）重建术中的骨修复。对于严重缺损，偶尔需要分阶段进行手术，首先对股骨和/或胫骨隧道进行骨移植。在这种情况下，同种异体骨的愈合率和质量各不相同，而且费用可能增加。传统的自体骨采集技术存在移植物体积有限和供区并发症的问题。我们的逆行股骨自体骨采集技术显示移植物的体积和质量极佳；并发症极少；手术便捷；隧道填充迅速且质量高，有助于进行解剖学上的二期翻修ACL重建。使用扩髓-冲洗-吸引器（Reamer-Irrigator-Aspirator，RIA）进行髓内骨移植已显示出在骨不连情况下的典型应用效果，尤其是在骨科创伤外科医生中。使用RIA 2（扩髓-冲洗-吸引器）系统（德普伊辛迪斯公司）进行自体骨移植的优点包括供区并发症少、骨移植物体积大、切口部位数量和大小减少、采集时间短以及愈合有效。该手术的目标是使用微创设备RIA 2安全有效地获取足够量的自体骨移植材料，用于二期翻修ACL重建。
