Reverse achilles tendon allograft technique for anterior cruciate ligament reconstruction

Because of the increasing popularity of allograft anterior cruciate ligament (ACL) reconstructions, the technical difficulties with posterior bone loss in revision ACL surgery, and the limited supply of bone-patellar tendon-bone donor grafts, we have developed a technique using a reversed Achilles tendon allograft to reconstruct the ACL-deficient knee. This technique allows for bony tibial fixation with an interference screw by rotating the graft 180 degrees and optimizing soft-tissue fixation at the femur with an EndoButton CL (Smith & Nephew, Andover, MA). Short-term follow-up (average, 26.4 weeks) of 10 patients undergoing the reversed Achilles technique has shown excellent results, with Lysholm scores between 91 and 100 and 84 and 90 in 8 of 10 and 2 of 10 patients, respectively. Objective stability assessments, including the Lachman test, anterior drawer, and pivot-shift tests, were also encouraging. Reverse Achilles tendon allografts can be excellent alternatives for ACL reconstruction when bone-patellar tendon-bone grafts are not indicated.