Allogenous Bone Grafting Technique for Staged Revision Anterior Cruciate Ligament Surgery

Tunnel widening, slightly malplaced former tunnels or bone loss due to hardware removal might prevent a 1-stage anterior cruciate ligament (ACL) revision procedure due to tunnel convergence or challenging graft fixation. A range of graft sources and bone grafting techniques are described-all with their strengths and limitations. Common autograft techniques come with substantial donor site morbidity that might hinder postoperative rehabilitation.

Graft tunnel issues might prompt the need for structural grafts and a 2-stage ACL revision approach. The use of the current dowel allograft technique gives a flexible approach where 1 or several cylindrical grafts can be placed in prepared sockets for reliable bony ingrowth.

Using femoral head allografts and cannulated coring reamers, multiple bone dowels (up to 6) can give a flexible and adaptable bone grafting situation. The intra-articular tunnels are dilated, and dowels are produced to allow a press-fit fixation that facilitates good bone healing. Removal of sclerotic bone and microfracture is key to allow optimal bone-to-bone healing. Use of cannulas inserted through the arthroscopic portals and tamps plug advancement will give a reliable graft deployment without dowel breakage.

The current authors have used this uniform technique for 119 patients since 2014. All cases displayed good bony healing at 5 months after surgery on computed tomography and radiographs, and 115 out of 119 went on to have a stage 2 revision ACL surgery at 6 months spacing from the bone grafting. The most common reason for not going through the second-stage revision was improvement of symptoms due to graft removal and bone grafting during the first surgery.

The current allograft dowel bone grafting allows for a flexible bone grafting in cases where a 1-step ACL revision procedure is not feasible. Reliable bony ingrowth is seen in the current cohort allowing the final step of ACL revision at 6 months spacing from bone grafting.

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