Fig 3.

Joint lavage and tunnel debridement. (A) Cleaning and debridement procedure for enlarged tunnels. The remains of the failed anterior cruciate ligament reconstruction undergo morcellation and are removed throughout the anteromedial portal (I) and the tibial tunnel incision (II). Once the tunnels are exposed, they are cleaned thoroughly. It is important to eliminate the remains of the fixation systems used in the previous operation. This may require an extra-articular approach when it comes to cortical suspension systems. Finally, curettage of the tunnels is performed to bring up healthy bleeding bone tissue. The use of electrocoagulation or radiofrequency systems should be avoided owing to the deleterious thermal effect on the bone walls (III). The objective is to achieve the best possible substrate for bone graft integration. (B) Arthroscopic image showing cleaning and debridement of femoral tunnel. The widening of the tunnel is clearly visible (I, red line). The burr (II) is introduced from the anteromedial portal while the procedure is controlled from the anterolateral portal. One of the screws (III, yellow line) used to secure the previous anterior cruciate ligament reconstruction is shown.