Allograft bone augmentation in anterior cruciate ligament reconstruction

Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure associated with predictable results in most patients. Intraoperative and postoperative complications can occur in up to 20% of surgeries and could result in the need for revision procedures. The following technical report describes the use of allograft corticocancellous bone for supplemental interference fixation of a bone-patellar tendon-bone ACL autograft within a tibial tunnel in which anterior widening occurred as a complication of reaming. This technique was used to obtain and improve aperture outlet fixation of the autograft within the tibial tunnel while maintaining adequate position and tension on the ACL graft-fixation construct. Clinical follow up at 36 months has revealed radiographic incorporation of the allograft into the tibial tunnel as well as optimal subjective, objective, and functional outcomes as measured by patient response, physical examination, and serial KT-1000 (MEDmetric, San Diego, CA) arthrometer data. This technique could be useful in revision cases in which tunnel enlargement and/or widening is noted.