Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 23, Issue 5 , Pages 558.e1-558.e4, May 2007

A New Harvest Site for Bone Graft in Anterior Cruciate Ligament Revision Surgery

  • Francesco Franceschi, M.D.

      Affiliations

    • Orthopaedic Department, Campus Biomedico, University of Rome, Rome, Italy
    • Corresponding Author InformationAddress correspondence and reprint requests to Francesco Franceschi, M.D., Orthopaedic Department, Campus Biomedico, University of Rome, Via Longoni 83, 00155 Rome, Italy.
    • ,
  • Rocco Papalia, M.D.

      Affiliations

    • Orthopaedic Department, Campus Biomedico, University of Rome, Rome, Italy
    • ,
  • Alberto Di Martino, M.D.

      Affiliations

    • Orthopaedic Department, Campus Biomedico, University of Rome, Rome, Italy
    • ,
  • Giacomo Rizzello, M.D.

      Affiliations

    • Orthopaedic Department, Campus Biomedico, University of Rome, Rome, Italy
    • ,
  • Robert Allaire, M.D.

      Affiliations

    • Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
    • ,
  • Vincenzo Denaro, M.D.

      Affiliations

    • Orthopaedic Department, Campus Biomedico, University of Rome, Rome, Italy

published online 08 January 2007.

Abstract 

During revision anterior cruciate ligament (ACL) surgery, femoral interference screws frequently require removal. This may lead to significant tunnel widening and possible graft fixation failure as a result. Solutions include drilling the revision tunnel in a different location, using stacked interference screws, or using bone graft to fill the defect. Autogenous iliac crest graft and allograft are both used, but there are significant comorbidities associated with each. We developed a new technique for harvesting autogenous bone graft that avoids many of the complications associated with other graft sources. By use of the existing surgical incision from the initial harvest of the bone–patellar tendon–bone autograft, bone from the medial tibial metaphyseal safe zone is harvested via an OATS tube harvester (Arthrex, Naples, FL). A bone plug 1 mm larger in size than the femoral defect is harvested and arthroscopically inserted via a press-fit technique. At 3 months after bone grafting, patients undergo revision ACL reconstruction. The proximal tibial metaphysis is a safe bone graft harvest site in revision ACL surgery and offers an effective method for filling large bony defects, allowing anatomic reconstruction of the ACL after bone healing has occurred. Furthermore, it eliminates the problems associated with allograft or use of a remote graft donor site.

Key Words: Anterior cruciate ligament, Autogenous bone graft, Proximal tibial metaphysis

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 The authors report no conflict of interest.Cite this article as: Franceschi F, Papalia R, Di Martino A, Rizzello G, Allaire R, Denaro V. A new harvest site for bone graft in anterior cruciate ligament revision surgery. Arthroscopy 2007;23:558.e1-558.e4 [doi:10.1016/j.arthro.2006.07.054].

PII: S0749-8063(06)00990-X

doi:10.1016/j.arthro.2006.07.054

Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 23, Issue 5 , Pages 558.e1-558.e4, May 2007

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