Arthroscopy - 2026-09-10 - Journal Article
Bone Grafting Using Manually Contoured Femoral Head and Neck Allograft Successfully Fills Femoral and Tibial Tunnel Osteolytic Defects in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Computed Tomography-Guided Analysis.
Hirpara A, Constantine E, Dragoo JL
Topics
Key Takeaway
Manually contoured femoral head and neck allograft achieves 92% tibial and 78–82% femoral tunnel filling by CT at a mean of 123 days, with lower cost than prefabricated dowels.
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Summary
This retrospective case series quantified CT-based tunnel filling after manually contoured femoral head and neck allograft bone grafting in 2-stage revision ACLR in patients under 50. Tibial tunnel filling reached 92.0% of the reamed tunnel at full depth and 80.4% of the total osteolytic defect; femoral filling was 77.9% and 68.1%, respectively, with tibial filling significantly greater than femoral (P<.05). No postoperative complications occurred, and femoral head and neck allograft was less costly than prefabricated bone dowels.
Key Limitation
The study reports only graft filling percentage at a single early CT timepoint (~4 months) without confirming cortical incorporation, trabecular bridging, or mechanical competence sufficient to support definitive fixation at stage 2.
Original Abstract
PURPOSE
To use computed tomography (CT) to quantify the percent filling of tibial and femoral tunnel osteolytic defects using a manually contoured femoral head and neck allograft prior to definitive revision anterior cruciate ligament reconstruction.
METHODS
Patients under 50 years were included if they underwent bone grafting of tibial and/or femoral tunnels with femoral head and neck allograft during 2-stage revision anterior cruciate ligament reconstruction between 2019 and 2024. Patients must have obtained a CT scan at a minimum of 3 months after bone grafting. Percent filling was calculated on axial CT as the ratio of the cross-sectional area of the graft to the reamed tunnel and to the total osteolytic defect. Percent filling was measured through the full tunnel depth and 15 mm from the intra-articular aperture. A cost-minimization analysis was performed comparing femoral head and neck allografts with prefabricated allograft bone dowels.
RESULTS
Twenty tibias and 15 femurs underwent bone grafting. Postoperative CT was obtained at an average of 123.0 ± 14.3 days (range: 109-169 days). Percent filling of tibial tunnels was 92.0% (reamed tunnel, full depth), 92.3% (reamed tunnel, 15 mm depth), 80.4% (entire defect, full depth), and 81.8% (entire defect, 15 mm depth). Percent filling of femoral tunnels was 77.9% (reamed tunnel, full depth), 82.0% (reamed tunnel, 15 mm depth), 68.1% (entire defect, full depth), and 71.3% (entire defect, 15 mm depth). Intraclass correlation coefficients for graft and tunnel measurements were 0.9897 and 0.9804, respectively. In 14 patients who underwent tibial and femoral tunnel bone grafting, paired analyses showed greater percent filling in tibial tunnels (P < .05). There were no postoperative complications. Femoral head and neck allografts were associated with lower costs compared with prefabricated dowels.
CONCLUSIONS
Manually contoured femoral head and neck allografts adequately fill osteolytic defects in tibial and femoral tunnels prior to definitive second-stage revision anterior cruciate ligament reconstruction.
LEVEL OF EVIDENCE
Level IV, retrospective case series.