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Femoral Tunnel Defect Filled With a Synthetic Dowel Graft for a Single-Staged Revision Anterior Cruciate Ligament Reconstruction

Published:February 16, 2007DOI:https://doi.org/10.1016/j.arthro.2006.10.025

      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.

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      References

        • L’Insalata J.C.
        • Klatt B.
        • Fu F.H.
        • Harner C.D.
        Tunnel expansion following anterior cruciate ligament reconstruction: A comparison of hamstring and patellar tendon autografts.
        Knee Surg Sports Traumatol Arthrosc. 1997; 5: 234-238
        • Thomas N.P.
        • Kankate R.
        • Wandless F.
        • Pandit H.
        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
        • Battaglia T.C.
        • Miller M.D.
        Management of bony deficiency in revision anterior cruciate ligament reconstruction using allograft bone dowels: Surgical technique.
        Arthroscopy. 2005; 21: E767
        • Wong J.W.
        • Yip D.K.
        The peashooter device: An invaluable tool for bone grafting during revision anterior cruciate ligament surgery.
        Arthroscopy. 2005; 21: E1010
        • Sgaglione N.A.
        • Miniaci A.
        • Gillogly S.D.
        • Carter T.R.
        Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee.
        Arthroscopy. 2002; 18: 9-32
        • Miller M.D.
        Revision cruciate ligament surgery with retention of femoral interference screws.
        Arthroscopy. 1998; 14: 111-114