Table 2.

Key Steps, Pearls, and Pitfalls of Allograft Bone Grafting

Key steps

•Conduct preoperative advanced imaging evaluation.

•Recognize concomitant pathology at time of arthroscopy.

•Determine width and depth of femoral and tibial tunnels.

•Create bone dowel from femoral head allograft using the Coring Reamer System (Arthrex, Naples, FL).

•Create weakened site in dowel at 5 mm greater than the corresponding depth of the femoral socket.

•Introduce dowel, loaded on guide wire, into femoral defect via tibial tunnel or anteromedial portal.

•Once femoral dowel is in place, use probe to break it completely at the weakened point and remove remnants.

•Reposition dowel remnants into the tibial defect.

Pearls

•Ensure you can attain the proper angle if using a trans-tibial route to introduce the dowel into the femur. If not, use an anteromedial portal or accessory medial portal.

•Measure the depth of the femoral tunnel accurately to create a dowel of the appropriate length.

•Creating a weakened site with a small bone bridge in the dowel facilitates arthroscopic breakage of it with a probe, allowing for quick transition to grafting the tibial defect.

Pitfalls

•Innacurate measuring of tunnel/socket width and depth and resultant dowel sizing error may necessitate repeat dowel harvesting.

•Aggressive malleting or introducing the dowel at an inappropriate angle risks breakage of it.