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Updated: Jul 4, 2026
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Stage I Revision ACL Reconstruction With Allograft Bone Dowels.
Stephen Marcaccio1, Robin Dunn1, Justin Arner1
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Video Journal of Sports Medicine
|May 1, 2025
Summary
Revision anterior cruciate ligament (ACL) reconstruction requires addressing original tunnel issues. Stage I revision ACL reconstruction uses allograft bone dowels to graft tunnels, enabling future anatomic graft placement.
Area of Science:
- Orthopedic surgery
- Sports medicine
- Biomedical engineering
Background:
- Evaluating failed anterior cruciate ligament (ACL) reconstruction necessitates thorough patient history and physical examination.
- Original tunnel size and position are critical factors in planning revision ACL reconstruction surgery.
- This video demonstrates a Stage I revision ACL reconstruction using allograft bone dowels for enlarged or poorly positioned original tunnels.
Purpose of the Study:
- To present a technique for bone grafting of previous tunnels in revision ACL reconstruction.
- To address situations where single-stage revision is not feasible due to tunnel condition.
- To facilitate anatomic graft placement in a subsequent stage.
Main Methods:
- The procedure involves arthroscopic debridement of the ACL graft remnant and existing tunnels.
- Femoral and tibial tunnels are reamed to the appropriate size using cannulated reamers.
- Allograft bone dowels are inserted into the prepared tunnels to augment bone stock.
Main Results:
- This technique allows for adequate bone grafting of compromised tunnels.
- It prepares the site for a second-stage revision ACL reconstruction.
- Radiographic incorporation of the bone graft is expected within 4 to 6 months.
Conclusions:
- Stage I revision ACL reconstruction with allograft bone dowel grafting is a viable option for managing problematic tunnels.
- This minimally invasive approach enables future anatomic graft placement and fixation.
- It is indicated when original tunnels are too large or malpositioned for immediate revision.
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