Scope Essentials 2024-When do I stage a Revision ACL Reconstruction

Video Transcription

Video Summary

Dr. Zichilli discusses when to stage revision ACL reconstructions, emphasizing that the first revision is the best chance for success and that autografts outperform allografts in outcomes and failure rates. Technical factors such as bone tunnel placement, tunnel size, and malposition (common in up to 50% of femoral tunnels and 22% of tibial tunnels) often influence the need for staging, especially with bone grafting. Concomitant injuries, including meniscal and cartilage damage, alignment issues, and extensor mechanism injuries, also affect timing and staging decisions. Surgeon experience and limiting operative time are crucial, particularly early in practice. Patient factors like rehabilitation grit, work demands, insurance, and preferences must be considered. When tunnels are compromised but patients desire single-stage surgery, specific techniques like bone graft dowels can be used. Ultimately, Dr. Zichilli advises that when uncertain, a staged approach is preferable, as two-stage revisions show better outcomes and lower failure rates than single-stage procedures.

Asset Caption

Michael Zacchilli, M.D.

Keywords

revision ACL reconstruction

autografts vs allografts

bone tunnel placement

concomitant knee injuries

staged surgery approach

surgeon experience and patient factors