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

Abstract

There has been extensive agreement that ligament reconstruction is an optimal treatment strategy for functional instability of the knee caused by anterior cruciate ligament (ACL) deficiency [1][2][3][4] . Lng-term outcomes of ACL reconstruction are good or excellent in terms of restoration of articular stability, improvement of symptoms, and return to preinjury activities (range, 75% to 97%) [1][2][3]5,6) .Unfortunately, 0.7%-20% of patients experience recurrent instability due to graft failure 4,[7][8][9][10][11] .Patients have a 5.4% risk of undergoing a revision surgery within five years after primary ACL reconstruciton 6) .In the USA, the annual incidence of ACL tears is approximately 1 in 3,000 people: more than 175,000 people had an ACL injury every year and about 100,000 operations were performed every year in the last decades [1][2][3]5,6,[12][13][14] .Considering the progressive increase in ACL injury and the need for reconstruction surgery 1,2,5) , it is reasonable to expect that the incidence of failure will also increase.A successful ACL revision surgery requires a methodical approach to identification and correction of all potential causes of failure.Thus, it is extremely important to make an accurate preoperative plan based on anamnesis and clinical and radiological evaluations.Several factors can influence the success of revision surgery including the preinjury laxity and integrity of secondary stabilizers; articular cartilage and meniscus status, graft type, surgical technique, rehabilitation, and patient's compliance, enthusiasm, and expectation 8) .Accurate identification of the cause of failure is needed to select the most appropriate revision strategy for each patient.For example, the operation can be carried out in one or two sessions

The authors' abstract, as published at the source. Knee Surgery and Related Research, 2016 · DOI ↗