Scientific justification and technique for anterior cruciate ligament reconstruction using autogenous and allogeneic soft-tissue grafts

The Bone Mulch Screw/WasherLoc technique provides a consistent, reliable method of anterior cruciate ligament (ACL) reconstruction using either autogenous or allogeneic soft tissue grafts. The tibial guide customizes placement of the tibial tunnel for each patient, thereby avoiding impingement of the graft against the roof in extension and impingement of the graft against the posterior cruciate ligament (PCL) in flexion. Correct placement of the femoral tunnel is automatic with the transtibial technique because the femoral tunnel is drilled through the tibial tunnel. Soft tissue grafts require better fixation than patellar tendon bone grafts because tendons heal more slowly during the first 6 weeks of implantation than a bone plug to a tunnel. High strength and stiffness fixation devices, which fix the graft outside the tunnel, optimize graft healing to bone and allows the safe use of aggressive brace-free rehabilitation with an early return to sport and work activities.