The peashooter device: an invaluable tool for bone grafting during revision anterior cruciate ligament surgery

Anterior cruciate ligament (ACL) reconstruction is a commonly performed surgery. Despite the improved technique and understanding of the rehabilitation rationale, the long-term success rate of good or excellent results is 75% to 90%. That leaves 10% to 25% of reconstructed ACLs with unsatisfactory results. Certainly, revision ACL surgery is not required in every patient. It should be individualized according to symptoms, objective findings, and the expectations of the patients. Revision of a failed ACL reconstruction may be carried out either as a single-stage procedure or a staged procedure. A staged procedure is recommended in cases of tunnel enlargement and/or removal of the implants and the failed graft, which leaves large bone defects. Bone grafting of the tibial bone tunnel defect is usually not a problem. On the other hand, grafting the femoral bone tunnel defect can present a challenge. It is important to place enough bone graft into the femoral tunnel securely and tightly so that bone incorporation takes place before the second-stage surgery, when the new tunnel can be drilled and the new ligament graft placed. We describe a simple technique using the elasticity and transparent properties of a chest drain, which effectively delivers the bone graft to the femoral tunnel defect. We name it the "peashooter device."