Fixation in revision ACL reconstruction

Abstract

Anterior cruciate ligament (ACL) revision reconstructions are likely to increase as the number of primary ACL reconstructions increases. Poor prior tunnel locations and tunnel expansion can complicate fixation of the graft in a revision setting, and thus the surgeon must be familiar with multiple different fixation methods, their advantages, disadvantages, and potential complications. This chapter reviews the various fixation types that can be used with soft tissue-to-bone or bone-to-bone fixation, the biomechanical properties of several common fixation devices, and offers technical advice for hardware removal and graft fixation in the setting of nearby prior tunnels or tunnel expansion.