Tunnelauffüllung bei zweizeitiger Revision am vorderen Kreuzband: Operationstechnik

Introduction: Indications for revision surgery of the anterior cruciate ligament (ACL) may result from ACL re-rupture, persistent or increasing instability or limited range of motion of the knee joint. A comprehensive analysis of possible causes of failure is absolutely essential in all cases. Material and methods: Besides the medical history and a clinical examination, conventional radiographs and computed tomography (CT) are necessary for evaluation of the position and the width of the primary bone tunnels. Partial anatomic tunnel placement and/or tunnel widening >15 mm, in particular, require a two-stage surgical procedure. In a first arthroscopic operation an arthroscopic debridement of the primary tunnels is carried out and subsequent filling with autologous bone material (e. g. from the iliac crest) or by synthetic bone substitutes. After a mean of 3–6 months a further CT scan is performed to evaluate the integration of the implanted bone. Afterwards a new ACL reconstruction can be performed in a second operation. Results and conclusion: According to the current literature ACL revision surgery in general shows significantly poorer clinical results in comparison to primary ACL reconstruction. Regarding the two-stage procedure in particular only few data are available, which do not allow any obvious conclusions to be drawn; therefore further studies are necessary.