One-Stage ACL Revision Using a Bone Allograft Plug for a Semianatomic Tibial Tunnel That Is Too Anterior

Simultaneous Tunnel Grafting and Anterior Cruciate Ligament Reconstructions Revision Using Double Suspensory Fixation: A Single-Stage Solution

“…Some single-stage methods might necessitate overreaming the tunnel to create fresh walls, even when not dilated, resulting in more metaphyseal bone defect. To address this issue, solutions include grafting the previous tunnel and making new ones, 11 , 12 , 13 utilizing larger screw fixation, using bone from the graft (Achilles tendon allograft with bone or semitendinosus autograft with bone), 14 occupying the bone void with stacked screw technique, 15 or making an “over-the-top” type of femoral tunnel to avoid tunnel overlap. 16 However, these solutions may not always yield superior metaphyseal fixation and outcomes.…”

Management of Bone Loss and Tunnel Widening in Revision ACL Reconstruction

“…BPTB or Achilles tendon allografts have larger bone blocks than would otherwise be available with autografts and can be tailored to fill a specific defect 69 . Philippe et al recently described a method for using a large bone plug to correct an anteriorly placed tibial tunnel 70 . The new anatomically positioned tunnel can be drilled despite overlapping the previous semi-anatomic or widened tunnel, and the bone plug can be shaped to fill the resultant defect in a 1-stage procedure.…”

Anterior cruciate ligament failure and management

“…For these cases, a two-stage procedure is more recommendable even though some rescue procedures that allow for a one-stage revision have been described. They described the different uses of bone impaction grafting to support the new bone tunnels circumferentially even in the case of mispositioning or severe osteolysis of the former tunnels ( 112 , 113 ).…”