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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