Revision ACL reconstruction is becoming more frequent especially in specialized centers, due to the large numbers of primary ACL procedures performed.

In two stage revisions, bone grafting of the tunnels may be undertaken if the primary position was inaccurate or if osteolysis has caused widening of the tunnels. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity.

It is technically difficult to deliver and impact bone graft into the femoral tunnel with the standard surgical and arthroscopic instruments.

We describe a new technique for femoral and tibial tunnels impaction grafting in two stage ACL revisions, utilizing the OATS grafting instruments.

The appropriately sized OATS harvester is chosen 1 mm larger than the tunnel size and is used to harvest bone graft from the iliac crest through a percutaneous approach. This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. The inside punch of the harvester is tapped, this allows delivery of the graft in a controlled manner, and allows impaction into the tunnel. The same is repeated for the tibial tunnel while providing support for the proximal end of the tunnel.