Anterior Cruciate Ligament Revision: Double-Bundle Augmentation of Primary Vertical Graft

Robert H. Brophy, Ronald M. Selby, David W. Altchek

Research output: Contribution to journalArticlepeer-review

47 Scopus citations


Abstract: 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.

Original languageEnglish
Pages (from-to)683.e1-683.e5
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Issue number6
StatePublished - Jun 1 2006


  • Anterior cruciate ligament
  • Double bundle
  • Reconstruction
  • Revision


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