Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 9/2020

Open Access 01-09-2020 | Computed Tomography | Arthroscopy and Sports Medicine

Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery

Authors: Wolf Christian Prall, T. Kusmenkov, B. Schmidt, J. Fürmetz, F. Haasters, J. H. Naendrup, W. Böcker, S. Shafizadeh, H. O. Mayr, T. R. Pfeiffer

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2020

Login to get access

Abstract

Objectives

Patients with recurrent instability after anterior cruciate ligament (ACL) reconstruction often present with enlarged or misplaced tunnels and bone grafting is required prior to the actual revision reconstruction. Autologous bone grafting features limited quantity and donor site morbidity. These problems may be eliminated utilizing cancellous bone allografts, but their efficiency and reliability have not been investigated systematically. The aim of the present study was to compare tunnel filling rates attained by utilizing either allogenic or autologous cancellous bone grafts.

Materials and methods

A total of 103 consecutive patients were enrolled retrospectively. All patients suffered from recurrent instability and underwent either allogenic or autologous cancellous bone grafting. Computed tomography (CT) was carried out before and after the bone grafting procedure. Based on preoperative CT scans, positioning and maximum diameter of the femoral and tibial tunnels were determined. Tunnel filling rates were calculated as a ratio of pre- and postoperative tunnel volumes. Primary outcome was the tibial tunnel filling rate. Femoral filling rates and density of the grafted bone were assessed secondarily.

Results

Preoperative CT scans revealed no significant differences between the two groups regarding distribution of misplacement and widening of the femoral or tibial tunnel. Postoperative CT scans were conducted after an interval of 5.2 months. Tunnel filling rates of 74.5% (± 14.3) femoral and 85.3% (± 10.3) tibial were achieved in the allogenic compared to 74.3% (± 15.9) femoral and 84.9% (± 9.4) tibial in the autologous group. With p values of 0.85 at the femur and 0.83 at the tibia, there were no significant differences between the groups. The density of the grafted bone revealed significantly higher values in the allogenic group.

Conclusions

Utilizing cancellous bone allografts in two-staged revision ACL surgery provides for sufficient and reproducible filling of enlarged or misplaced tunnels. The filling rates are comparable to those achieved with autologous bone grafting. Advantages of allografts are the unrestricted quantity and the absence of any harvesting procedure.
Literature
1.
Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA et al (2016) Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med 44(6):1502–1507PubMed
2.
Zbrojkiewicz D, Vertullo C, Grayson JE (2018) Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. Med J Aust 208(8):354–358PubMed
3.
Buller LT, Best MJ, Baraga MG, Kaplan LD (2015) Trends in anterior cruciate ligament reconstruction in the United States. Orthop J Sports Med 3(1):2325967114563664PubMed
4.
Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BR Jr et al (2014) Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 42(10):2363–2370PubMed
5.
Ulstein S, Aroen A, Engebretsen L, Forssblad M, Lygre SHL, Rotterud JH (2018) Effect of concomitant cartilage lesions on patient-reported outcomes after anterior cruciate ligament reconstruction: a nationwide cohort study from Norway and Sweden of 8470 patients with 5-year follow-up. Orthop J Sports Med 6(7):2325967118786219PubMedPubMedCentral
6.
Prentice HA, Lind M, Mouton C, Persson A, Magnusson H, Gabr A et al (2018) Patient demographic and surgical characteristics in anterior cruciate ligament reconstruction: a description of registries from six countries. Br J Sports Med 52(11):716–722PubMed
7.
Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD (2016) Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med 44(7):1861–1876PubMedPubMedCentral
8.
Lefevre N, Klouche S, Mirouse G, Herman S, Gerometta A, Bohu Y (2017) Return to sport after primary and revision anterior cruciate ligament reconstruction: a prospective comparative study of 552 patients from the FAST cohort. Am J Sports Med 45(1):34–41PubMed
9.
Weiler A, Schmeling A, Stohr I, Kaab MJ, Wagner M (2007) Primary versus single-stage revision anterior cruciate ligament reconstruction using autologous hamstring tendon grafts: a prospective matched-group analysis. Am J Sports Med 35(10):1643–1652PubMed
10.
Group M, Wright RW, Huston LJ, Spindler KP, Dunn WR, Haas AK et al (2010) Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Am J Sports Med. 38(10):1979–1986
11.
Wright RW, Gill CS, Chen L, Brophy RH, Matava MJ, Smith MV et al (2012) Outcome of revision anterior cruciate ligament reconstruction: a systematic review. J Bone Jt Surg Am 94(6):531–536
12.
Cheatham SA, Johnson DL (2013) Anticipating problems unique to revision ACL surgery. Sports Med Arthrosc 21(2):129–134PubMed
13.
Richter DL, Werner BC, Miller MD (2017) Surgical pearls in revision anterior cruciate ligament surgery: when must i stage? Clin Sports Med 36(1):173–187PubMed
14.
Zantop T, Petersen W (2011) Arthroscopic filling of misplaced and wide bone tunnels after reconstruction of the anterior cruciate ligament with bone graft in patients with recurrent instability. Oper Orthop Traumatol 23(4):337–350PubMed
15.
Said HG, Baloch K, Green M (2006) A new technique for femoral and tibial tunnel bone grafting using the OATS harvesters in revision anterior cruciate ligament reconstruction. Arthroscopy 22(7):796e1–3
16.
Thomas NP, Kankate R, Wandless F, Pandit H (2005) Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel. Am J Sports Med 33(11):1701–1709PubMed
17.
Franceschi F, Papalia R, Del Buono A, Zampogna B, Diaz Balzani L, Maffulli N et al (2013) Two-stage procedure in anterior cruciate ligament revision surgery: a five-year follow-up prospective study. Int Orthop 37(7):1369–1374PubMedPubMedCentral
18.
von Recum J, Schwaab J, Guehring T, Grutzner PA, Schnetzke M (2017) Bone incorporation of silicate-substituted calcium phosphate in 2-stage revision anterior cruciate ligament reconstruction: a histologic and radiographic study. Arthroscopy 33(4):819–827
19.
Uchida R, Toritsuka Y, Mae T, Kusano M, Ohzono K (2016) Healing of tibial bone tunnels after bone grafting for staged revision anterior cruciate ligament surgery: a prospective computed tomography analysis. Knee 23(5):830–836PubMed
20.
Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 42(Suppl 2):S3–15PubMed
21.
Erickson BJ, Cvetanovich G, Waliullah K, Khair M, Smith P, Bach B Jr et al (2016) Two-stage revision anterior cruciate ligament reconstruction. Orthopedics 39(3):e456–e464PubMed
22.
Prall WC, Kusmenkov T, Furmetz J, Haasters F, Mayr HO, Bocker W et al (2019) Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. Injury 50(2):467–475PubMed
23.
Bernard M, Hertel P (1996) Intraoperative and postoperative insertion control of anterior cruciate ligament-plasty. A radiologic measuring method (quadrant method). Unfallchirurg 99(5):332–340PubMed
24.
Sirleo L, Innocenti M, Innocenti M, Civinini R, Carulli C, Matassi F (2018) Post-operative 3D CT feedback improves accuracy and precision in the learning curve of anatomic ACL femoral tunnel placement. Knee Surg Sports Traumatol Arthrosc 26(2):468–477PubMed
25.
Lertwanich P, Martins CA, Asai S, Ingham SJ, Smolinski P, Fu FH (2011) Anterior cruciate ligament tunnel position measurement reliability on 3-dimensional reconstructed computed tomography. Arthroscopy 27(3):391–398PubMed
26.
Sadoghi P, Kropfl A, Jansson V, Muller PE, Pietschmann MF, Fischmeister MF (2011) Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction. Arthroscopy 27(3):355–364PubMed
27.
Grote S, Helfen T, Muck F, Regauer M, Prall WC (2015) Femoral marrow cavity bone harvesting used for arthroscopic refilling of misplaced or enlarged bone tunnels in revision ACL surgery: an arthroscopically supported technique with antegrade intramedullary bone harvesting by a reamer-irrigator-aspirator (RIA) system. Knee Surg Sports Traumatol Arthrosc 23(3):808–815PubMed
28.
Tie K, Wang H, Wang X, Chen L (2012) Measurement of bone mineral density in the tunnel regions for anterior cruciate ligament reconstruction by dual-energy X-ray absorptiometry, computed tomography scan, and the immersion technique based on Archimedes' principle. Arthroscopy 28(10):1464–1471PubMed
29.
Vap AR, Persson A, Fenstad AM, Moatshe G, LaPrade RF, Engebretsen L (2019) Re-revision anterior cruciate ligament reconstruction: an evaluation from the Norwegian Knee Ligament Registry. Arthroscopy 35(6):1695–1701PubMed
30.
Group M (2016) Factors influencing graft choice in revision anterior cruciate ligament reconstruction in the MARS group. J Knee Surg 29(6):458–463
31.
Lind M, Menhert F, Pedersen AB (2012) Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions. Am J Sports Med 40(7):1551–1557PubMed
32.
Salem HS, Axibal DP, Wolcott ML, Vidal AF, McCarty EC, Bravman JT et al (2020) Two-stage revision anterior cruciate ligament reconstruction: a systematic review of bone graft options for tunnel augmentation. Am J Sports Med 48(3):767–777PubMed
33.
Schuttler KF, Hoeger A, Heyse TJ, Figiel J, Timmesfeld N, Stein T et al (2018) Femoral tunnel widening is associated with tunnel malposition but not with clinical failure after medial patellofemoral ligament reconstruction with a free gracilis tendon graft. Arch Orthop Trauma Surg 138(7):979–984PubMed
34.
Mauffrey C, Madsen M, Bowles RJ, Seligson D (2012) Bone graft harvest site options in orthopaedic trauma: a prospective in vivo quantification study. Injury 43(3):323–326PubMed
35.
Goulet JA, Senunas LE, De Silva GL, Greenfield ML (1997) Autogenous iliac crest bone graft. Complications and functional assessment. Clin Orthop Relat Res. 339:76–81
36.
Joshi A, Kostakis GC (2004) An investigation of post-operative morbidity following iliac crest graft harvesting. Br Dent J 196(3):167–171 (discussion 55)PubMed
37.
Pruss A, Baumann B, Seibold M, Kao M, Tintelnot K, von Versen R et al (2001) Validation of the sterilization procedure of allogeneic avital bone transplants using peracetic acid-ethanol. Biologicals 29(2):59–66PubMed
38.
Pruss A, Perka C, Degenhardt P, Maronna U, Buttner-Janz K, Paul B et al (2002) Clinical efficacy and compatibility of allogeneic avital tissue transplants sterilized with a peracetic acid/ethanol mixture. Cell Tissue Bank 3(4):235–243PubMed
Metadata
Title
Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery
Authors
Wolf Christian Prall
T. Kusmenkov
B. Schmidt
J. Fürmetz
F. Haasters
J. H. Naendrup
W. Böcker
S. Shafizadeh
H. O. Mayr
T. R. Pfeiffer
Publication date
01-09-2020
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 9/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-020-03421-7

Other articles of this Issue 9/2020

Archives of Orthopaedic and Trauma Surgery 9/2020 Go to the issue

Trauma Surgery

Incidence, diagnostics and treatment algorithm of nerve lesions after traumatic shoulder dislocations: a retrospective multicenter study

Orthopaedic Surgery

Lumbar spinal fusion of low-grade degenerative spondylolisthesis (Meyerding grade I and II): Do reduction and correction of the radiological sagittal parameters correlate with better clinical outcome?

Trauma Surgery

Postoperative results of Ogawa type IIB meta-acromion fracture fixation with a 90° twisted reconstruction plate

Knee Arthroplasty

Cosmetic outcomes and patient satisfaction compared between staples and subcuticular suture technique for wound closure after primary total knee arthroplasty: a randomized controlled trial

Orthopaedic Surgery

The use of accelerometer-based navigation for coronal TKA alignment: a prospective, single surgeon comparative study

Trauma Surgery

Extracorporal shock wave therapy for the treatment of arthrodesis non-unions