IC104
Innovative Techniques for ACL Revision Surgery
Roberto Rossi, MD; Davide E. Bonasia MD; Christopher D. Harner MD; Jacques Menetrey, MD; Sven Scheffler, MD
Course Description:
Revision ACL reconstruction has shown inferior outcomes compared with primary ACL reconstruction, and this can be due to different factors, including bone defects, concomitant misdiagnosed peripheral instability, malalignment, chondral and meniscal lesions/degeneration. In some cases, mostly when primary ACL tunnels are malpositioned and there is no significant bone loss, ACL revision can be a relatively straightforward procedure. However, in most patients with failed ACL reconstruction, many factors should be considered during the planning and pre-operative work-up. During the first part of the IC, participants will be provided with the tools to understand the reasons for ACL failure and correctly plan the ACL revision surgery. In ACL revision surgery there are no standardized procedures and the surgery should be tailored for each specific case. When approaching this type of surgery, the surgeon should be familiar with unconventional ACL revision techniques in order to deal with different scenarios. In the second, case-based part of the IC, various uncommon surgical procedures will be described. These techniques can sometimes be valuable tools to avoid problems like proximal graft fixation, interference with previous tunnels, marked rotatory instability, malalignment, cartilage damage, and meniscal deficiency. The IC will focus on the following topics:
- Pre-operative planning and decision making
- Two stage ACL revision
- One stage ACL revision with lateral plasty and anatomic/non-anatomic ACL reconstruction: Marcacci, Saragaglia, Yamaguchi techniques
- One stage revision with over the top femoral position
- Combined ACL revision and medial meniscus transplant
- Combined ACL revision and HTO
Course Objectives:
- Learn how to perform correct planning and pre-operative work-up in ACL revision surgery.
- Learn various unconventional techniques to avoid intraoperative troubles in ACL revision surgery
- Learn indications and technical aspects of procedures combined to ACL revision: meniscal transplant and high tibial osteotomy.