Management of Bony Deficiency in Revision Anterior Cruciate Ligament Reconstruction Using Allograft Bone Dowels: Surgical Technique

Revision anterior cruciate ligament (ACL) reconstruction surgery has become increasingly common over the past decade and its popularity is likely to rise further as the number of primary ACL reconstructions increases each year. More than 75% of all cases of failed ACL reconstruction are the result of technical error and, of these, more than 70% are attributed specifically to malpositioned tunnels. Management of tunnel malposition in revision surgery often requires innovative approaches for dealing with the resultant bony defects. In addition, tunnel osteolysis may create bone loss that interferes with desired tunnel placement. A number of options have been described for handling these bony deficiencies, many of which are technically difficult and time consuming. We describe a novel technique to address bony defects during revision ACL reconstruction using freeze-dried allograft bone dowels. These allografts are readily available and can be used easily to fill deficiencies resulting from previous tunnels or osteolysis. The grafts provide sufficient structural support for redrilling of new tunnels through or next to the bony plug, allowing uncompromised tunnel placement.