Try to avoid Revision - Deutsche Kniegesellschaft

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Try to avoid Revision - Deutsche Kniegesellschaft
Revision after double-bundle
ACL-reconstruction
Eichhorn HJ, Weiler A
Please – when you do cruciate surgery
Think about revision
Revision surgery becomes the next
important problem
in cruciate surgery
Re-Rupture:
What is an „adequat“ Trauma
?
Double-bundle Revision
More challenging:
Double Boundle / Double Trouble
Doppelbündel - Revisionen
Easier:
Small
- tibial converging
- femoral diverging
Drill-holes
Revisionen
Try to avoid Revision:
- Graft pre-conditioning
- precize placement of the tunnels
- drill holes in 0,5 mm steps
-Pressfit
Revisionen
Try to avoid Revision:
-Minimize material in the tunnel
-Stress-sharing of the bundles
-Individual tensioning of the bundles
infrastructure
Double – bundle graft procedure
archieves excellent results...
... but
...staff and skill demanding !!!
Periost
Problem Analysis
Combined pathology
AMRI / PLRI
Problem Analysis
Tunnel position
femoral
Problem Analysis
Tunnel position
tibial
Difficult to remove
Experience :
adsorbable PLA Screws lead to avital
bone structure !
Composit (TCP)
Difficult to remove
Revision:
DB with double-plate and doublemini-disc-Fixation
No Hardware Problems
High noon - Position
12
1
2
3
High-noon Position
AM
K-WIRE
AM
AM
PASSING
SUTURE
AM
PL
Revisionen
CT Evaluation of the Tunnels
(bone stock)
Revisions-Operationen
If in doubt ( > 10 mm ):
Bone Graft of the tunnels
(iliac crest)
Revisionen
DB Revision:
Quadrizepstendon in the
Bone-Wedge Hybrid-Fixation
Technique
TCP
TCP
tibial
femoral
instruments
„The race for
quality has no
finish line !!!“
Thank You for
Your Attention !

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