Single-stage revision anterior cruciate ligament reconstruction using bone grafting for posterior or widening tibial tunnels restores stability of the knee and improves clinical outcomes. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Dragoo, J. L., Kalisvaart, M., Smith, K. M., Pappas, G., Golish, R. 2019


PURPOSE: Revision ACL surgery may be complicated by tunnel malposition and/or tunnel widening and often requires a staged treatment approach that includes bone grafting, a period of several months to allow bone graft incorporation and then definitive revision ACL reconstruction. The purpose of this study was to evaluate the results of a single-staged ACL revision reconstruction technique using a cylindrical dowel bone graft for patients who have existing posteriorly placed and/or widened tibial tunnels in the tibia at a minimum of 2years follow-up.METHODS: Between 2010 and 2014, patients undergoing single-stage revision ACL reconstruction with the described technique were prospectively enrolled and evaluated. At a minimum of 24months, patients were evaluated by physical examination, multiple clinical outcome instruments including KOOS, Tegner and Lysholm, and preoperative and postoperative MRIs.RESULTS: At a mean of 35.1months, 18 consecutive patients had no revision surgery and no subjective knee instability. There were statistically significant improvements in the Tegner (median 2, interquartile range 2.25; p<0.01), Lysholm (20.0±15.0; p<0.01), KOOS symptoms scale (12.9±11.8; p<0.01), KOOS pain scale (15.4±18.7; p<0.01), KOOS ADL scale (13.5±19.0; p<0.01), KOOS sports scale (32.8±26.4; p<0.01), and KOOS QoL scale (18.1±16.9; p<0.01). Postoperative MRI demonstrated statistically significant anteriorization of the tibial tunnel and a statistically significant decrease in tunnel widening.CONCLUSION: Revision ACL reconstruction utilizing a single-staged tibial tunnel grafting technique resulted in improved knee pain, function, and stability at a minimum of 24-month follow-up.LEVEL OF EVIDENCE: IV.

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