What constitutes ACL reconstruction failure?
ACL reconstruction is successful in the great majority of patients, but patients need to be aware that failure can occur. ACL graft failure is not always a catastrophic event, but may also include laxity and instability, pain, stiffness and further damage to other structures.
Peer-reviewed papersQuote from peer-reviewed paper:
....indications for revision surgery [include]....
- a complete graft tear with > 6 mm of anterior tibial displacement as compared to healthy knee;
- a positive pivot shift test graded +2 or +3 compared to the healthy knee, with or without knee pain or inflammation, or subjective sensation of instability or functional limitations for daily life and/or sports activities
Citation: Samitier G, Marcano AI, Alentorn-Geli E, Cugat R, Farmer KW, Moser MW. Failure of Anterior Cruciate Ligament Reconstruction. Arch Bone Jt Surg. 2015 Oct;3(4):220-40. PMID: 26550585; PMCID: PMC4628627.
How does an ACL revision differ from the original ACL reconstruction?
Generally the original ACL reconstruction would have used the patient's own patellar tendon (B-PT-B) or hamstrings tendon.
The problem is that if that procedure fails then the patient no longer has a fully healthy tendon for the revision surgery.
Patient and surgeon may decide on harvesting tendons from the other side, using a different tendon (like quads tendon) or using an allograft (from a tissue lab.) or an artificial ligament. It is also an option to augment a tendon procedure with artificial material.
Peer-reviewed papersQuote from peer-reviewed paper:
"....It is vital to identify the cause(s) of failure of the previous surgery and rectify them whilst avoiding the same errors again....[Surgery may be a] complex undertaking due to limited graft options and compromised anatomy. Associated injuries to meniscus, cartilage, and anterolateral capsule are very common and need to be suitably addressed...."
Citation: Tapasvi S, Shekhar A. Revision ACL Reconstruction: Principles and Practice. Indian J Orthop. 2021 Jan 19;55(2):263-275. doi: 10.1007/s43465-020-00328-8. PMID: 33927805; PMCID: PMC8046893.
Forum discussions
- please give advice an graft selection, im freaking out.
A long discussion with a patient having a primary reconstruction, but there is a lot of experience there with revision procedures also.
- Quadriceps tendon graft
A patient has had ACL graft failure of his hamstrings graft, and is asking about how challenging rehabilitation might be if the surgeon uses the quads tendon next.