Abstract
The purpose of this study was to determine the most common causes of failed anterior
cruciate ligament reconstruction (ACLR) using modern reconstructive techniques at
a single, high-volume institution. In addition, the clinical outcomes of patients
undergoing revision ACLR will be reported. The surgical logs of four senior knee surgeons
were retrospectively reviewed for all patients who had undergone ACLR between 2002
and 2009. Patients were excluded if they did not have both the primary and revision
surgery on the same knee with the same surgeon. Out of 1944 ACL reconstructions, 28
patients (56 reconstructions) were included in the study. Radiographic studies, operative
reports, KT-1000 scores, and chart notes were used to identify all potential factors
that may have led to failure. All patients were invited to return for a follow-up
examination and survey. Of the 28 patients, the mean age at the index and revision
procedure was 22 ± 11 (range, 12 to 50) and 24 ± 11 (range, 14 to 57), respectively.
In 20 cases, the cause of failure was determined to be acute trauma (sports, work,
or accident); in 1 case, the cause was biologic failure; while in 7 cases, the cause
was technical error. During the study period the surgeons performed a combined total
of 1944 procedures, for an overall failure rate of 1.8%. Twenty patients (71%) were
available for follow-up at a mean 30.2 ± 17.7 months. The overall postrevision outcomes
were good to excellent for a majority of patients, with an average Lysholm score of
84 ± 15.5 and International Knee Documentation Committee score of 77.2 ± 13.8. The
pre- and postoperative KT-1000 scores were 12.1 ± 2.8 and 6.7 ± 2.8, respectively.
The results from this study suggest that traumatic re-injury, and not surgical/surgeon
error, is the most common cause of ACLR failure using anatomic reconstructive principles
and strong fixation. In addition, good to excellent outcomes following revision ACLR
can be expected in the majority of patients.
Keywords
anterior cruciate ligament reconstruction - revision - failure - bone tunnel
