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 !