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Management of Bone Loss/Osteolysis in Revision ACL Reconstruction: The Role of Two-Stage Reconstruction

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Revision Anterior Cruciate Ligament Reconstruction

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Abstract

As the number of primary anterior cruciate ligament (ACL) reconstructions performed annually continues to rise, the number of revision ACL reconstructions required is expected to climb in parallel. Depending on the type and location of fixation, size and location of existing tunnels, and bone quality, the surgeon must be prepared to perform a two-stage reconstruction when indicated. The most common indication to perform a two-stage revision ACL reconstruction with bone grafting is tunnel expansion from osteolysis or a bone defect. Furthermore, other clinical scenarios such as index tunnel malposition, malalignment requiring a corrective osteotomy, or infection may influence the decision to perform a two-stage reconstruction. To optimize outcomes, the index tunnels should not compromise the accurate placement of femoral and tibial tunnels. Furthermore, tunnel expansion from hardware removal or osteolysis must not jeopardize graft fixation and incorporation. In this chapter, we discuss the role of two-stage ACL reconstruction and present cases highlighting techniques and pearls for managing bone loss and tunnel osteolysis.

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Author information

Authors and Affiliations

  1. OrthoIllinois, Algonquin, IL, USA

    Cort D. Lawton

  2. Emory University, Department of Orthopedic Surgery, Atlanta, GA, USA

    Joseph D. Lamplot

  3. Hospital for Special Surgery, Sports Medicine Institute, New York, NY, USA

    Anil S. Ranawat & Robert G. Marx

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  1. Cort D. Lawton
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  2. Joseph D. Lamplot
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  3. Anil S. Ranawat
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  4. Robert G. Marx
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Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Division of Sports Medicine, New York University Langone Health, New York, NY, USA

    Michael J. Alaia

  2. Department of Orthopaedic Surgery, Division of Sports Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Kristofer J. Jones

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Lawton, C.D., Lamplot, J.D., Ranawat, A.S., Marx, R.G. (2022). Management of Bone Loss/Osteolysis in Revision ACL Reconstruction: The Role of Two-Stage Reconstruction. In: Alaia, M.J., Jones, K.J. (eds) Revision Anterior Cruciate Ligament Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-96996-7_8

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  • DOI: https://doi.org/10.1007/978-3-030-96996-7_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-96995-0

  • Online ISBN: 978-3-030-96996-7

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