Abstract
Bone defects are a common obstacle to successful revision anterior cruciate ligament
(ACL) reconstruction. We describe the use of a synthetic bone graft plug to fill a
cylindric defect after femoral interference screw removal. During revision ACL reconstruction
performed through a 2-incision technique, we placed an outside-in guidewire for a
new femoral tunnel that converged with the femoral screw from the primary ACL reconstruction.
The screw was removed, and the resultant defect appeared very similar to the cylindric
bone defect left after an osteochondral graft harvest. The confluence of the defect
and the planned femoral tunnel would have allowed a “windshield wiper” effect of the
graft at the lateral wall of the notch. We filled the screw defect with a synthetic
bone graft plug to limit the aperture size of the femoral tunnel and to buttress the
tendinous portion of the revision ACL graft, while maintaining proper anatomic graft
position. In this article, we present a readily available all-arthroscopic option
for repairing cylindric bone defects without the risk of an allograft or the morbidity
of an autograft for a single-stage revision ACL reconstruction.
Key Words
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References
- Tunnel expansion following anterior cruciate ligament reconstruction: A comparison of hamstring and patellar tendon autografts.Knee Surg Sports Traumatol Arthrosc. 1997; 5: 234-238
- Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel.Am J Sports Med. 2005; 33: 1701-1709
- Management of bony deficiency in revision anterior cruciate ligament reconstruction using allograft bone dowels: Surgical technique.Arthroscopy. 2005; 21: E767
- The peashooter device: An invaluable tool for bone grafting during revision anterior cruciate ligament surgery.Arthroscopy. 2005; 21: E1010
- Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee.Arthroscopy. 2002; 18: 9-32
- Revision cruciate ligament surgery with retention of femoral interference screws.Arthroscopy. 1998; 14: 111-114
Article info
Publication history
Published online: February 16, 2007
Footnotes
The authors report no conflict of interest.
Cite this article as: Barrett GR, Brown TD. Femoral tunnel defect filled with a synthetic dowel graft for a single-staged revision anterior cruciate ligament reconstruction. Arthroscopy 2007;23:796.e1-796.e4 [doi:10.1016/j.arthro.2006.10.025].
Identification
Copyright
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
