Clinical Outcomes of Single-Stage Revision Anterior Cruciate Ligament Reconstruction Using a Fast-Setting Bone Graft Substitute

Abstract

Revision anterior cruciate ligament reconstruction (ACLR) can be achieved in a single-stage or two-stage approach. Single-stage revisions have several advantages, including one less operation, decreased cost, and a quicker recovery for patients. Revision ACLR can be complicated by malpositioned or dilated bone tunnels, which makes a single-stage revision more challenging or sometimes necessitates a two-stage approach. The use of fast-setting bone graft substitutes (BGS) has been described in recent literature as a strategy to potentially help address this problem in the setting of single-stage revision ACLR. The aim of this study was to evaluate patient-reported clinical outcomes of patients who have undergone single-stage revision ACLR using fast-setting BGS to address prior malpositioned or dilated tunnels. A retrospective review was conducted of the first nine consecutive patients who had undergone single-stage revision ACLR using a fast-setting BGS by a single surgeon between May 2017 and February 2020 with a minimum of 2-year follow-up. Patient-reported clinical outcomes, including the International Knee Documentation Committee (IKDC) questionnaire, the Tegner Lysholm Knee Scoring Scale, patient satisfaction questions, and the need for additional surgery were evaluated for this group between 26 and 49 months postoperative. Of the nine patients eligible for inclusion, eight patients (88.9%) were evaluated, and one was lost to follow-up. At an average follow-up of 37.9 months (range: 27.8–55.7), the mean postoperative IKDC score was 75.0 ± 11.3, and the mean postoperative Tegner Lysholm Knee Score was 83.0 ± 17.6. None of the patients required additional revision surgery or experienced construct failure at the time of follow-up. Seven of eight respondents (87.5%) had their preoperative expectations met with the surgery, and 100% of patients stated they would have the surgery again. Single-stage revision ACLR using fast-setting BGS showed overall positive clinical outcomes for this pilot group of patients at a minimum 2-year follow-up. In select revision scenarios, these materials may be a valuable option to allow the filling of defects without compromising fixation or clinical outcomes.

Keywords

ACL reconstruction - bone graft substitutes - revision ACLR - grafting ACL tunnels

Publication History

Received: 02 August 2023

Accepted: 23 October 2023

Article published online:
04 December 2023

• References

• 1 Wilde J, Bedi A, Altchek DW. Revision anterior cruciate ligament reconstruction. Sports Health 2014; 6 (06) 504-518
• 2 Sanders TL, Maradit Kremers H, Bryan AJ. et al. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med 2016; 44 (06) 1502-1507
• 3 Mayr R, Rosenberger R, Agraharam D, Smekal V, El Attal R. Revision anterior cruciate ligament reconstruction: an update. Arch Orthop Trauma Surg 2012; 132 (09) 1299-1313
• 4 Werner BC, Gilmore CJ, Hamann JC. et al. Revision anterior cruciate ligament reconstruction: results of a single-stage approach using allograft dowel bone grafting for femoral defects. J Am Acad Orthop Surg 2016; 24 (08) 581-587
• 5 Miller MD, Kew ME, Quinn CA. Anterior cruciate ligament revision reconstruction. J Am Acad Orthop Surg 2021; 29 (17) 723-731
• 6 Buyukdogan K, Laidlaw MS, Miller MD. Two-stage revision anterior cruciate ligament reconstruction using allograft bone dowels. Arthrosc Tech 2017; 6 (04) e1297-e1302
• 7 Salem HS, Axibal DP, Wolcott ML. et al. Two-stage revision anterior cruciate ligament reconstruction: a systematic review of bone graft options for tunnel augmentation. Am J Sports Med 2020; 48 (03) 767-777
• 8 Serbin PA, Griffin JW, Bonner KF. Single-stage revision anterior cruciate ligament reconstruction using fast-setting bone graft substitutes. Arthrosc Tech 2020; 9 (02) e225-e231
• 9 McLaren AC, Estes CS. Orthopaedic applications of injectable biomaterials. Injectable Biomaterials 2011; 8: 202-226
• 10 Kolk A, Handschel J, Drescher W. et al. Current trends and future perspectives of bone substitute materials - from space holders to innovative biomaterials. J Craniomaxillofac Surg 2012; 40 (08) 706-718
• 11 Colatruglio M, Flanigan DC, Long J, DiBartola AC, Magnussen RA. Outcomes of 1- versus 2-stage revision anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med 2021; 49 (03) 798-804
• 12 Mathew CJ, Palmer JE, Lambert BS, Harris JD, McCulloch PC. Single-stage versus two-stage revision anterior cruciate ligament reconstruction: a systematic review. J ISAKOS 2018; 3: 345-351
• 13 Lee DW, Kim JG, Cho SI, Kim DH. Clinical outcomes of isolated revision anterior cruciate ligament reconstruction or in combination with anatomic anterolateral ligament reconstruction. Am J Sports Med 2019; 47 (02) 324-333
• 14 Fox JA, Pierce M, Bojchuk J, Hayden J, Bush-Joseph CA, Bach Jr BR. Revision anterior cruciate ligament reconstruction with nonirradiated fresh-frozen patellar tendon allograft. Arthroscopy 2004; 20 (08) 787-794
• 15 von Recum J, Gehm J, Guehring T. et al. Autologous bone graft versus silicate-substituted calcium phosphate in the treatment of tunnel defects in 2-stage revision anterior cruciate ligament reconstruction: a prospective, randomized controlled study with a minimum follow-up of 2 years. Arthroscopy 2020; 36 (01) 178-185
• 16 Vaughn ZD, Schmidt J, Lindsey DP, Dragoo JL. Biomechanical evaluation of a 1-stage revision anterior cruciate ligament reconstruction technique using a structural bone void filler for femoral fixation. Arthroscopy 2009; 25 (09) 1011-1018
• 17 Tse BK, Vaughn ZD, Lindsey DP, Dragoo JL. Evaluation of a one-stage ACL revision technique using bone void filler after cyclic loading. Knee 2012; 19 (04) 477-481
• 18 Sgaglione NA, Douglas JA. Allograft bone augmentation in anterior cruciate ligament reconstruction. Arthroscopy 2004; 20 (Suppl. 02) 171-177