Autologous Bone Graft Harvest Technique Using Reamer-Irrigator-Aspirator for 2-Stage Revision Anterior Cruciate Ligament Reconstruction

Abstract

Autologous or allograft bone grafting is commonly used for bone restoration in the setting of revision anterior cruciate ligament (ACL) reconstruction owing to bone loss or malpositioned or osteolytic tunnels. For significant defects, staged procedures with initial bone grafting to the femoral and/or tibial tunnels is occasionally required. In this setting, allograft shows variable rates and quality of healing and can incur increased expense. Historical techniques of autograft harvest are associated with limited graft volume and donor-site morbidity. Our technique of retrograde femoral autograft harvest shows excellent volume and quality of graft; minimal morbidity; operative expediency; and rapid, quality tunnel filling to facilitate an anatomic second-stage revision ACL reconstruction. Intramedullary bone graft harvest using a Reamer-Irrigator-Aspirator has shown efficacy for typical use in the setting of nonunion, particularly among orthopaedic trauma surgeons. Advantages of using the RIA 2 (Reamer-Irrigator-Aspirator) system (DePuy Synthes) for autologous bone graft harvest include lower donor-site morbidity, greater bone graft volume, decrease in number and size of incision sites, shorter harvest time, and efficacious healing. The goal of this procedure is to obtain an adequate amount of autologous bone graft using a minimally invasive device, RIA 2, safely and efficiently for a 2-stage revision ACL reconstruction.