Bone Marrow Aspirate Concentrate With Two-Staged-Revision ACL Reconstruction

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Regenerative Medicine

Background:

• Rising incidence of anterior cruciate ligament (ACL) injuries, reconstructions, and re-ruptures necessitates advanced surgical techniques.
• Failed ACL reconstructions lead to poorer outcomes than primary reconstructions, driving innovation in surgical and biologic treatments.
• Two-stage ACL revision is preferred for cases with significant bone loss or malpositioned tunnels, while one-stage is also effective.

Purpose of the Study:

• To describe a surgical technique for revision ACL reconstruction utilizing bone marrow aspirate concentrate (BMAC).
• To highlight the benefits of BMAC in enhancing graft integration and promoting accelerated ligamentization.
• To inform surgeons about the efficacy of BMAC in managing ACL graft failures.

Main Methods:

• Surgical technique involves debriding fibrous tissue from tunnel apertures and removing old graft remnants.
• Bone marrow aspirate concentrate (BMAC) is prepared and injected into the tunnels with demineralized bone matrix.
• Allograft bone dowels are used to reconstruct the tunnel, followed by standard graft fixation.

Main Results:

• Patients are expected to experience improved knee-specific quality of life and reduced pain within two years post-surgery.
• Successful return to activities is a key outcome measure for patients undergoing revision ACL reconstruction.
• No significant differences in outcomes were observed between one-stage and two-stage ACL revision approaches.

Conclusions:

• Advancements in understanding BMAC's role in ACL reconstruction warrant its consideration for indicated patients.
• BMAC shows promise in improving clinical outcomes, graft integration, and ligamentization after revision ACL surgery.
• This technique offers a valuable option for managing complex ACL graft failures.