SINGLE-STAGE ACL REVISION RECONTRUCTION
The primary graft must be debrided and a decision concerning the removal of fixation deviced will be made. A single-stage revision may or may not require removing the original hardware in either the femoral or tibial tunnel. If the primary graft was placed in a more vertical position versus an anatomical position on the femur, then removal of hardware may not have to be done.
Once in the knee arthroscopically, Dr. Lowe may decide to debride the graft and leave your hardware in place in your old tunnel and use new hardware in the new tunnel. In some cases, Dr. Lowe is able to remove the hardware and use the same tunnels to reconstruct the ACL. However, this is not a common occurrence since the stresses that tear the reconstructed ligament also tend to widen out the tunnels. If the tunnels are too big, there is no way to secure the new graft properly and bone grafting will be required. If original hardware is removed, Dr. Lowe usually performs a bone graft or uses a different type of bone plug in its place.
With the failed graft removed, the hardware removed if needed, Dr. Lowe can progress with reconstructing the ACL with a new graft.
Some single stage revisions require a more extensive length of healing and some modifications to the patient's post-operative care may be made as deemed necessary by Dr. Lowe. Usually these modifications include weight-bearing status, range of motion limitations, and following our ACL Delayed protocol versus the ACL Accelerated protocol. Determination between which protocol the patient will be following post-operatively depends greatly on the type of bone grafts used if the hardware is removed.
An ACL graft reconstructed in the proper positioning and fixation is always susceptible to re-tearing or re-injury. Most revisions in the single stage category generally use either the existing tunnels or completely new tunnels without the removal of hardware.