A Newer Technique of Extended Cortical Fixation to Salvage Intratunnel Blowout during Revision Anterior Cruciate Ligament Reconstruction - A Case Report.

Introduction: Posterior femur wall blowout and consequent loss of femoral graft fixation are commonly encountered distally at the aperture of the tunnel facing into the joint during anterior cruciate ligament (ACL) reconstruction. However, intratunnel blowout of femoral tunnel at its outer cortical opening during a revision ACL reconstruction is very rare. It compromises the mechanical strength of the cortical bone at the tunnel opening on lateral cortex, making it weaker for providing stability to endobutton. We report this very rare event of intratunnel blowout of femoral tunnel at its proximal opening on the lateral femoral cortex during a revision ACL reconstruction, where the patient was treated with a modification in the suspensory fixation technique using a suture disc.

Case Report: Two years following a primary ACL reconstruction, our patient presented with a lax knee. Radiography and magnetic resonance imaging images showed malpositioning of femoral endobutton, lax, and degenerated autograft. During revision, we encountered intratunnel blowout at outer opening on lateral femoral cortex. It was rescued with a modification in the suspensory fixation technique by tying the endobutton with a suture-disc, placed directly over the proximal opening of femoral tunnel on lateral cortex.

Conclusion: Our case report highlights, this rare critical surgical event during revision ACL reconstruction managed successfully with a suture disc, which is cost-effective, readily available and using the same prepared graft within a lesser operative time. Functional outcome was excellent and usage of a suture disc.