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
