What Grafts Do You Use for Revision ACL Reconstruction?

My choice is to generally use allograft tissue for revision anterior cruciate ligament (ACL) reconstruction. Allograft tissue has several specific advantages. Allograft provides availability of a large graft, which can be especially useful in the setting of bone tunnel enlargement. Bone deficiency may also be caused by removal of hardware or other fixation devices used for the primary ACL reconstruction. Allograft also eliminates donor site morbidity, which is more of a concern in revision ligament surgery where there is scarring from prior surgery. Patients undergoing revision surgery may have some degree of patellofemoral degeneration, making bone-patellar tendon-bone or quadriceps tendon-bone autograft less attractive. A further advantage of allograft is to decrease surgical time, which is relevant in revision ACL surgery since these knees often require additional meniscal or ligament surgery.