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Review Article|Articles in Press

Consistent Indications and Good Outcomes Despite High Variability in Techniques for Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review

Published:February 28, 2023DOI:https://doi.org/10.1016/j.arthro.2023.02.009

      Abstract

      Purpose

      To systematically review the current literature regarding the indications, techniques, and outcomes following two-stage revision anterior cruciate ligament reconstruction (ACLR).

      Methods

      A literature search was performed using SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement. Inclusion criteria was limited to level I-IV human studies reporting on indications, surgical techniques, imaging, and/or clinical outcomes of two-stage revision ACLR.

      Results

      Thirteen studies with 355 patients treated with two-stage revision ACLR were identified. The most commonly reported indications were tunnel malposition and tunnel widening, with knee instability being the most common symptomatic indication. Tunnel diameter threshold for two-stage reconstruction ranged from 10 to 14mm. The most common grafts used for primary ACLR were bone-patellar-tendon-bone (BPTB) autograft, hamstring graft, and LARS (polyethylene terephthalate) synthetic graft. The time elapsed from primary ACLR to the first stage surgery ranged from 1.7 years to 9.7 years, while the time elapsed between the first and second stage ranged from 21 weeks to 13.6 months. Six different bone grafting options were reported, with the most common being iliac crest autograft, allograft bone dowels, and allograft bone chips. During definitive reconstruction, hamstring autograft and bone-patellar-tendon-bone autograft were the most commonly utilized grafts. Studies reporting patient-reported outcome measures showed improvement from preoperative to postoperative levels in Lysholm, Tegner, and Objective IKDC scores.

      Conclusions

      Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. Bone grafting is commonly reported using iliac crest autograft and allograft bone chips and dowels, while hamstring autograft and BPTB autograft were the most utilized grafts during the second-stage definitive reconstruction. Studies showed improvements from preoperative to postoperative levels in commonly utilized patient reported outcomes measures.

      Level of Evidence

      Systematic Review, Level IV.

      Keywords

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