Autologous Iliac Crest Bone Graft After Anterior Cruciate Ligament Reconstruction Failure in Patients With Both Femoral and Tibial Tunnel Enlargement

Tunnel enlargement is a common challenge in revision anterior cruciate ligament reconstruction and compromises graft fixation and biological integration. Traditional 2-stage revision procedures prolong treatment duration and increase patient morbidity. We describe a technique using autologous cancellous bone harvested from the ipsilateral iliac crest to restore femoral and tibial tunnel bone stock after anterior cruciate ligament reconstruction failure. This technique focuses on managing tunnel enlargement and prepares the tunnels for subsequent anterior cruciate ligament revision. Arthroscopic impaction of autologous bone restores tunnel geometry and provides a favorable biological environment for fixation. In selected patients, this approach may shorten rehabilitation time and eliminate the need for staged surgery.