Anterior cruciate ligament revision: double-bundle augmentation of primary vertical graft

Arthroscopy. 2006 Jun;22(6):683.e1-5. doi: 10.1016/j.arthro.2005.08.051.


A variety of factors contribute to the failure of primary anterior cruciate ligament (ACL) reconstruction; most commonly, it is technical error related to tunnel placement. Recently, the increasing popularity of the all-endoscopic ACL reconstruction and concern about graft impingement may have led to more posterior placement of the tibial tunnel by surgeons. Working through a tibial tunnel placed too posterior makes it more difficult to recognize the correct starting position on the femur, and more likely to start the femoral tunnel in a central 12 o'clock position. The combination of subtle posterior placement of the tibial tunnel and central placement of the femoral tunnel results in a graft that is malpositioned in both the sagittal and coronal planes--a "vertical graft." We present a novel method of ACL revision surgery applicable to a specific subset of ACL revision patients with an intact "vertical graft" and instability that is rotational more than translational. In these patients, a double-bundle revision ACL augmentation technique can be used, leaving the original graft in place. A new tibial tunnel is placed anterior to the original and a new femoral tunnel lateral to the original. Reconstruction is performed with allograft and the combined ACL construct provides robust translational and rotational stability to the tibiofemoral joint.

MeSH terms

  • Anterior Cruciate Ligament / surgery*
  • Bone-Patellar Tendon-Bone Grafting / methods*
  • Endoscopy / adverse effects*
  • Humans
  • Reconstructive Surgical Procedures / adverse effects*
  • Reoperation
  • Treatment Failure