What happens in a two-stage revision ACL operation?

Why two operations are sometimes safer

A new graft needs solid bone around it to heal. If the tunnels from the first operation have widened, or sit where the new tunnels need to go, drilling through them can leave the new graft in loose or weak bone. Filling the old tunnels first, and letting that bone heal, gives the second reconstruction a firmer base.

When the old tunnels are well placed, or can simply be avoided, a single-stage revision is usually possible. The CT scan before surgery is what usually decides.

The first stage

• Arthroscopy to examine the joint and treat the meniscus or cartilage if needed
• Removal of old screws or other fixation where they are in the way
• Cleaning of the tunnels and filling them with bone graft, from your own bone or a donor source
• Usually a short hospital stay, with crutches for a period afterwards

Between the two operations

This interval often lasts several months, and a CT scan is usually repeated to confirm that the grafted bone has filled in. During this time the knee is still without a working ACL, so pivoting sport stays off limits. Physiotherapy keeps the knee fully straight, the swelling down and the muscles strong, which makes recovery from the second operation smoother.

Many people return to desk work fairly quickly after the first stage. Physical jobs and long-distance travel are discussed individually.

The second stage and planning in Qatar

The second operation is the ACL reconstruction itself, often with a graft from a different site and sometimes with an added lateral reinforcement. Because two procedures are planned, it helps to check early with your insurer what pre-approval is needed for each stage, and to plan leave from work and help at home around both dates.