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Femoral marrow cavity bone harvesting used for arthroscopic refilling of misplaced or enlarged bone tunnels in revision ACL surgery

An arthroscopically supported technique with antegrade intramedullary bone harvesting by a reamer–irrigator–aspirator (RIA) system

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In anterior cruciate ligament (ACL) revision surgery, refilling of misplaced or enlarged tunnels frequently requires bone harvesting from the iliac crest. Unfortunately, donor-site pain displays a relevant complication. In order to optimize patients’ comfort, we developed a procedure combining minimally invasive intramedullary bone harvesting from the femur with arthroscopic tunnel refilling.

Methods

Patients with ACL reconstruction failure that were not eligible for one-step revision surgery but required tunnel refilling prior to the next ACL reconstruction were enrolled prospectively. Cancellous bone was harvested intramedullarily from the ipsilateral femur using the reamer–irrigator–aspirator system in a minimally invasive manner. Afterwards, the femoral and tibial tunnels were arthroscopically refilled using cones and push rods. Computer tomography (CT) analyses were carried out before and after the filling procedure. Pain levels were assessed during the entire follow-up. Patients undergoing iliac crest bone harvesting for other reasons served as a control group. Finally, the quality of the newly formed bone stock was evaluated in the subsequent ACL reconstruction procedure.

Results

Five patients were included during a 6-month period. Prior to refilling, tunnel analysis revealed a mean tunnel volume of 7.9 cm3 at the femur [SD ±5.3 cm3] and of 6.7 cm3 [SD ±5.1 cm3] at the tibia. The CT analyses further revealed that graft failure was predominantly caused by tunnel misplacement. Post-operatively, pain levels due to intramedullary bone harvesting were significantly lower compared to iliac crest bone harvesting at every analysed time point. Three to five months after tunnel filling, CT analyses showed sufficiently incorporated bone stocks with filling rates of 75 % femoral and 94 % tibial. ACL revision surgery was performed 4–5 months after tunnel filling without any complication.

Conclusion

Intramedullary bone harvesting from the ipsilateral femur combined with arthroscopic refilling of the bone tunnels ensures a high-quality bone stock for further ACL reconstruction. The clinical relevance is shown by the feasibility of this technique and the significantly reduced pain levels during post-operative recovery.

Level of evidence

Therapeutic study, Level III.

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Acknowledgments

We thank Joachim Dewes (DePuy-Synthes, Umkrich, Germany) for technical assistance with the RIA® Systems and Hella Thun (Ludwig-Maximilians-University) for the figure illustrations. We further thank Dr. Hans Polzer and Tanya Reid Prall for carefully reading and correcting the manuscript.

Conflict of interest

The authors declare that there is no conflict of interest; all mentioned companies were not involved in this trail.

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Authors and Affiliations

  1. Section of Arthroscopic Surgery, Department of Trauma Surgery, Ludwig-Maximilians-University Munich, Campus Innenstadt, Nußbaumstr. 20, 80336, Munich, Germany

    S. Grote, T. Helfen, M. Regauer & W. C. Prall

  2. Institute of Radiology, Ludwig-Maximilians-University Munich, Nußbaumstr. 20, 80336, Munich, Germany

    F. Mück

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  1. S. Grote
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  2. T. Helfen
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Correspondence to S. Grote.

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Grote, S., Helfen, T., Mück, F. et al. Femoral marrow cavity bone harvesting used for arthroscopic refilling of misplaced or enlarged bone tunnels in revision ACL surgery. Knee Surg Sports Traumatol Arthrosc 23, 808–815 (2015). https://doi.org/10.1007/s00167-013-2736-0

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