Practical Approach to Address Failed ACL Reconstruction Surgery

The causes of ACL reconstruction (ACLR) failure can be divided into 3 major categories. Non-anatomic tunnel placement has been the most widely stated technical error in ACL repair. A thorough medical history is necessary and crucial to determine the likely cause of failure in the initial surgery. As such, the medical history and physical examination should be evaluated. In addition, physical examination of the knee should be performed such as alignment of lower extremities, existence of varus and or valgus deformity, presence of contractures in flexion or extension and special tests to evaluate ACL. Moreover, imaging by radiography which includes anteroposterior, lateral, Merchant and Rosenberg views must be consider evaluating. Failure of an ACLR may not necessarily need revision surgery. Patients with bi/tri-compartmental arthritis or regional pain syndromes, those without recurring instability, those who live a sedentary lifestyle, or those who refuse to participate in post-operative rehabilitation may not be ideal candidates for revision ACLR. Patients with a failed ACL reconstruction commonly presenting with sign and symptoms of instability, stiffness, and pain. The choice of graft is critical to procedure’s success. In the revision setting, fixation is just as critical as graft selection. The aim of the revision surgery is to stabilize the knee joint, prevent further damage to the cartilage and the menisci, and allow the patient to resume normal daily and/or sports activities. A successful revision surgery requires accurate preoperative patient evaluation and knee imaging.