Etiologic Factors That Lead to Failure After Primary Anterior Cruciate Ligament Surgery

Anterior cruciate ligament (ACL) reconstruction is common in the active young population. Failure of ACL reconstruction can be due to continued or recurrent instability, stiffness, or patient-reported failure in the setting of seemingly successful surgical reconstruction, such as pain that limits activity. Multiple preoperative, intraoperative, and postoperative variables can be optimized to give the greatest likelihood of success. Some of these include timing of surgery, identification, and treatment of associated ligamentous, meniscal and chondral injuries, tunnel placement, graft choice, fixation, tensioning, and postoperative rehabilitation. This article reviews common causes of ACL reconstruction failure concentrating on modifiable factors.