Arthroscopic Bone Grafting of Anterior Cruciate Ligament and Posterior Cruciate Ligament Tibial and Femoral Tunnels as a First-Stage Procedure.

Recurrent multiligament knee injuries present unique challenges when performing revision ligament reconstructions. Bone tunnel widening is relatively common and considered a multifactorial condition that involves both biomechanical and biologic factors. When indicated, two-stage procedures ensure optimal revision reconstruction tunnel sizes and locations before ligament reconstruction and promote improved outcomes. Staged bone grafting is required when addressing significant tunnel widening and improper tunnel placement that puts graft incorporation at increased risk in ligament reconstructions of the knee. In this Technical Note, we describe the first stage of a two-stage procedure to address meniscus/chondral conditions, tunnel osteolysis from previous reconstructions, and tibial and femoral bone grafting for the anterior cruciate ligament and posterior cruciate ligament.