Anterior Cruciate Ligament Revision Using Bone-Patellar Tendon-Bone Autograft and Lateral Extra-articular Tenodesis

Revision of anterior cruciate ligament reconstruction presents various challenges not encountered in the primary settings, including malpositioned tunnels, tunnel widening, and the lack of consensus on the ideal graft to be used. This Technical Note describes a one-stage anterior cruciate ligament reconstruction revision using a bone-patellar tendon-bone autograft combined with lateral extra-articular tenodesis. This technique represents the ideal approach to tackle complex revision cases primarily characterized by tibial and femoral tunnel osteolysis and rotational knee instability. The bone-patellar tendon-bone autograft offers numerous advantages mainly providing a double bone plug, which is critical when encountering cases with tibial and femoral tunnel widening. In addition, a lateral extra-articular tenodesis alongside the revision enhances rotational knee stability reducing stress on the graft and ensuring better graft survival.