Surgical Considerations in Revision ACL Reconstruction (AANA19)-Case Presentations_ Surgical Considerations in Revision ACL Reconstruction-Dr. Michael J. Alaia, M.D.

Case Presentations_ Surgical Considerations in Revision ACL Reconstruction-Dr. Michael J. Alaia, M.D.

Video Transcription

Video Summary

The discussion focuses on a 25-year-old male patient presenting with a failed ACL reconstruction after a non-contact skateboarding injury. Experts reviewed imaging, noting the femoral tunnel was slightly anterior and distal with small graft size. Concerns were raised about tunnel positioning and size, influencing revision surgery planning. Consensus was toward a one-stage revision using a bone-patellar tendon-bone (B-T-B) autograft or quadriceps tendon, with intraoperative assessment guiding graft choice. The lateral meniscus root avulsion was repaired concurrently. Surgical nuances included potential tunnel convergence, fixation challenges, and using bone dowels to optimize fixation. Postoperative strategies emphasized delaying graft harvest until intraoperative evaluation confirmed tunnel suitability. The panel also debated managing meniscal defects during revision ACL, preferring to complete ACL revision first and consider meniscal transplant later. Autografts were favored over allografts for revisions due to better bone incorporation and less tunnel osteolysis. Overall, the case illustrated decision-making complexities in revision ACL with concomitant meniscal injury.

Asset Caption

Instructional Course Lecture: Surgical Considerations in Revision ACL Reconstruction

Keywords

ACL revision surgery

bone-patellar tendon-bone autograft

femoral tunnel positioning

meniscal root repair

skateboarding injury