✅ Knee MRI Mastery/Chap 2.ACL and PCL

(Fig 2-D.21) Two-Stage ACL Revision

MSK MRI 2024. 3. 10. 00:07

https://youtu.be/A-BQcvJa_eg

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1️⃣ Single vs. Two-Stage Surgery

  • Studies published to date support that a tunnel diameter greater than 15 mm will require two-stage surgery when the original tunnels are in anatomical position. 
  • Conversely, a revision with a tunnel diameter of less than 10 mm can typically be accomplished in a single surgery. For tunnels measuring 10–15 mm, the approach differs based on the tunnel shape, position, and the treating surgeon’s preference.

2️⃣ Two-Stage Reconstruction Explained

  • Initial Stage: Removal and Filling
    A two-stage reconstruction involves removing the torn graft and filling the tunnels with bone graft. 
  • This is then left to heal over some time, typically 12–16 weeks.
  • Second Stage: Evaluation and Reconstruction
  • Approximately 12–16 weeks later, the grafts are evaluated with imaging to assess the degree of incorporation and the quality of the bone. 
  • If these factors are deemed adequate, the second stage of the ACL reconstruction is then performed.

3️⃣ Importance of CT in Two-Stage Reconstructions

  • CT scans play a crucial role in assessing the tunnel for widening and estimating the degree of bone graft incorporation in cases of two-stage revisions. 
  • It is considered more accurate and reliable than MRI for evaluating tunnel morphology with precise tunnel measurements.
  • Skeletal Radiol. 2017 Feb;46(2):161-169

 

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