Barnes Ryan H, Kaeding Christopher C, Magnussen Robert A, Flanigan David C
Jameson Crane Sports Medicine Institute and Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA.
Video J Sports Med. 2023 Oct 27;3(5):26350254231209333. doi: 10.1177/26350254231209333. eCollection 2023 Sep-Oct.
Anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and due to the increased number of primary reconstructions being performed, the number of revision ACL reconstructions is also increasing.
Two-stage revision ACL reconstruction has lower failure rates compared to 1-stage and is indicated when significant tunnel expansion has occurred or malpositioned tunnels prohibit an adequate reconstruction. In this presentation, 2-stage revision ACL reconstruction was performed with an arthroscopic bone grafting technique of both the femoral and tibial tunnels secondary to tunnel osteolysis.
Standard diagnostic arthroscopy is performed, and any chondral or meniscal pathology is addressed. The remnant ACL graft and all hardware are removed. The tunnels are debrided thoroughly. Using a modified syringe, the tunnels are packed with a mixture of cancellous bone chips and cortical fibers that have been hydrated with whole blood and platelet-rich plasma (PRP). The patient is placed into a brace postoperatively, and a computed tomography (CT) is obtained approximately 4 to 6 months postoperatively to assess for bone healing. Revision ACL reconstruction is performed once indicated with standard rehabilitation and return to play protocol.
Both 1-stage and 2-stage revision ACL reconstructions have been demonstrated to have significant improvement in outcomes scores preoperatively to postoperatively. However, 2-stage has lower failure rates compared to single-stage and has a high return to level of play.
DISCUSSION/CONCLUSION: Revision ACL reconstruction is becoming more commonly performed, and 2-stage revision is frequently required due to multiple factors. In this video, we demonstrate bone grafting for revision ACL reconstruction for tunnel osteolysis.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
前交叉韧带（ACL）重建是一种常见的骨科手术，由于初次重建手术数量的增加，ACL翻修重建的数量也在上升。
与一期翻修相比，二期翻修ACL重建的失败率更低，当出现明显的隧道扩张或隧道位置不当妨碍进行充分重建时适用。在本病例中，由于隧道骨质溶解，采用关节镜下股骨和胫骨隧道植骨技术进行了二期翻修ACL重建。
进行标准的诊断性关节镜检查，并处理任何软骨或半月板病变。移除残留的ACL移植物和所有硬件。彻底清理隧道。使用改良注射器，将已用全血和富血小板血浆（PRP）水化的松质骨碎片和皮质纤维混合物填充到隧道中。术后将患者置于支具中，并在术后约4至6个月进行计算机断层扫描（CT）以评估骨愈合情况。一旦有指征，按照标准康复方案和重返运动方案进行翻修ACL重建。
一期和二期翻修ACL重建均已证明术后结果评分较术前有显著改善。然而，二期翻修的失败率低于一期，且重返运动水平较高。
讨论/结论：ACL翻修重建越来越常见，由于多种因素，经常需要进行二期翻修。在本视频中，我们展示了针对隧道骨质溶解的翻修ACL重建的植骨技术。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可被识别，作者已随本投稿包含患者的豁免声明或其他书面批准形式以供发表。
