Arthroscopic Delivery of Injectable Bone Graft for Staged Revision Anterior Cruciate Ligament Reconstruction Kent T. Yamaguchi, M.D., Gina M. Mosich,

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Arthroscopic Delivery of Injectable Bone Graft for Staged Revision Anterior Cruciate Ligament Reconstruction Kent T. Yamaguchi, M.D., Gina M. Mosich, M.D., Kristofer J. Jones, M.D. Arthroscopy Techniques Volume 6, Issue 6, Pages e2223-e2227 (December 2017) DOI: 10.1016/j.eats.2017.08.025 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A, B) Anteroposterior and lateral knee radiographs showing bone tunnel positioning, widening, and retained biocomposite screw. (C) Sagittal magnetic resonance imaging showing insufficiency of the anterior cruciate ligament graft. (D-F) Coronal and axial computed tomography images showing bone tunnel dilatation (femoral, 15.7 mm; tibial, 9.8 mm). We elected not to graft the tibia because the tunnel dimensions were acceptable. Arthroscopy Techniques 2017 6, e2223-e2227DOI: (10.1016/j.eats.2017.08.025) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) Arthroscopic view of the OsteoPrecision cannula inserted through the anteromedial portal under dry conditions and the graft material being injected under direct visualization, delivering the injectable bone graft with the knee drained of fluid. (ACL, anterior cruciate ligament; PCL, posterior cruciate ligament.) (B) Arthroscopic view of the entire femoral tunnel through the anterolateral portal with a 70° arthroscope. (C) Arthroscopic view of the femoral tunnel after complete graft fill. Arthroscopy Techniques 2017 6, e2223-e2227DOI: (10.1016/j.eats.2017.08.025) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Additional case of a 28-year-old patient with failed double-bundle anterior cruciate ligament (ACL) reconstruction and excessive loss of bone stock requiring bone grafting of the femoral tunnels. (A, B) Arthroscopic images showing the tunnels after debridement. (C) Arthroscopic view of the anteromedial bundle tunnel after complete allograft fill. (D, E) At the time of revision ACL reconstruction, the tunnels were found to be completely filled with bone. Given the complete graft consolidation, we were able to perform anatomic drilling and ACL graft placement. Arthroscopy Techniques 2017 6, e2223-e2227DOI: (10.1016/j.eats.2017.08.025) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions