Surgical Considerations in Revision ACL Reconstruction (AANA19)-Mangement of Bone Tunnels and Bone Loss In Revision ACL Surgery-Dr. Bryson Patrick Lesniak, M.D.

Mangement of Bone Tunnels and Bone Loss In Revision ACL Surgery-Dr. Bryson Patrick Lesniak, M.D.

Video Transcription

Video Summary

The speaker discusses bone tunnel positioning and bone loss challenges in revision ACL surgery. Non-anatomic or malpositioned tunnels, both femoral and tibial, significantly contribute to ACL graft failure, with studies showing up to half of failures involving femoral tunnel misplacement. Correct tunnel placement using intraoperative landmarks, fluoroscopy, and multiple arthroscopic portals is critical to improve outcomes. The speaker compares one-stage versus two-stage revision surgeries: one-stage allows quicker recovery but may necessitate allografts for larger tunnels (>12mm), potentially increasing failure risk; two-stage involves bone grafting and delayed definitive surgery, offering better tunnel preparation but needing multiple procedures. The talk introduces a revised classification system for revision types, based on tunnel condition, guiding surgical approaches. Techniques such as bone dowels, over-the-top reconstruction, or drilling adjacent tunnels address various tunnel problems. Emphasis is placed on individualized surgical planning, careful assessment with radiographs and 3D CT scans, patient counseling, and readiness to modify plans intraoperatively to optimize revision outcomes.

Asset Caption

Instructional Course Lecture: Surgical Considerations in Revision ACL Reconstruction

Keywords

ACL revision surgery

bone tunnel positioning

femoral tunnel misplacement

one-stage vs two-stage revision

tunnel classification system