Causes of Failure of Anterior Cruciate Ligament Reconstruction and Revision Surgical Strategies

Overview

Journal Knee Surg Relat Res

Publisher Biomed Central

Date 2016 Nov 29

PMID 27894180

Citations 46

Authors

Paolo Di Benedetto

Enrico Di Benedetto

Andrea Fiocchi

Alessandro Beltrame

Araldo Causero

Affiliations

Soon will be listed here.

Abstract

Purpose: Long-term outcomes of anterior cruciate ligament (ACL) reconstruction are good or excellent; however, 0.7%-20% of patients suffer from recurrent instability due to graft failure. The purpose of this paper was to analyse failure aetiology and the possibilities of revision surgical strategies, with a description of our experience. We obtained optimal and good results in most of our patients.

Materials And Methods: We retrospectively reviewed 42 patients who underwent revision surgery (43 revisions) due to relapsing instability after ACL reconstruction between 2006 and 2015. We used allografts in 39 cases and autografts in 4 cases.

Results: The 85.7% of the patients obtained optimal results (normal knee; group A) and the 7.2% obtained good results (nearly normal knee; group B) according to the International Knee Documentation Committee score. The most frequent failure causes were traumatic events, non-anatomic tunnel placement, and lack of graft incorporation.

Conclusions: A correct revision surgery requires accurate patient evaluation and knee imaging. Preoperative planning starts with the identification of the cause of failure of the primary reconstruction. Then, the most suitable procedure should be determined for each case. It is also important to accurately inform the patient of all the complexity of an ACL revision surgery even if it is a procedure with high rates of excellent and good outcomes.

Citing Articles

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Two-stage revision anterior cruciate ligament reconstruction reduces failure risk but leads to lesser clinical outcomes than single-stage revision after primary anterior cruciate ligament graft failure: a retrospective cohort study.

Ifarraguerri A, Graham G, White A, Berk A, Gachigi K, Siparsky P Knee Surg Relat Res. 2025; 37(1):5.

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Evaluation of retear rates following transtibial anterior cruciate ligament reconstruction: Functional outcomes and GNRB assessment with a mean 6.3-year follow-up.

Unal P, Samargandi R, Saad M, Turbillon C, Schmitt A, Berhouet J J Orthop. 2024; 62():56-61.

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Yensen K, Mayfield C, Bolia I, Palmer R, Brown M, Kim D Sports Health. 2024; 17(2):243-251.

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