Evaluation of a one-stage ACL revision technique using bone void filler after cyclic loading

Revision anterior cruciate ligament (ACL) reconstruction often requires a two-stage approach. This study analyzes the biomechanical properties after cyclic loading of a one-stage ACL revision technique using a calcium phosphate bone cement.

Arthroscopic reconstruction of the ACL was performed in 5 matched pairs of fresh-frozen cadaveric knees separated into two groups. The control group underwent a standard reconstruction with a bone-patellar tendon-bone autograft with bioabsorbable interference screw fixation. The experimental group simulated a failed reconstruction by drilling a 12 mm hole and underwent a revision after filling it with a bioabsorbable calcium phosphate bone cement. The specimens were dissected, scanned for bone mineral density, and cyclically loaded on a mechanical testing system (preload of 250 cycles of 5-75 N at 0.5 Hz followed by 10,000 cycles of 20-150 N at 1 Hz). Intact specifmens underwent a load-to-failure protocol of 50mm/min. Ultimate load, stiffness, and modes of failure were recorded. Data was analyzed using paired t-tests.

All specimens completed the mechanical testing protocol. The control group had a mean maximum load of 471.33 N (SD 220.73 N) and the experimental group had 453.54 N (SD 152.36; p=0.84). There were no statistically significant differences in maximum load or stiffness. No correlation between bone mineral density (BMD) and maximum load was found.

Using calcium phosphate filler in a single-stage ACL revision is biomechanically viable. Further testing of long-term incorporation of the ACL graft in an animal model, along with human clinical trials, should be performed before there is clinical acceptance of this technique.