Causes of failed anterior cruciate ligament reconstruction: A retrospective case series

The number of anterior cruciate ligament reconstruction (ACLR) surgeries in China is steadily increasing. To enhance the success rate of ACLR, it is crucial to understand the reasons for ACLR failure. The purpose of this study is to determine the primary reasons for ACLR failure and evaluate the technical skills associated with the revision procedure.

A retrospective clinical data analysis was performed for all patients who underwent anterior cruciate ligament revision surgery between January 2014 and September 2022. Each patient's data set consisted of the 3 items listed below: standardized imaging data, medical records, and all arthroscopic images and recordings from the revision surgery.

A total of 65 patients underwent a failed ACLR surgery and then had to undergo revision surgery. Among these patients, the causes of revision were inappropriate tunnel placement (12, 18.75%), graft fixation problems (4, 6.25%), traumatic reinjury (35, 54.69%), graft failure (8, 12.5%), multiple ligament injuries (1, 1.56%), and infection (5, 7.81%).

In patients with inappropriate tunnel placement, the femoral canal deviated anteriorly in 6 cases, posteriorly in 4 cases, and the tibial canal deviated anteriorly in 2 cases. In patients with graft fixation failure, the loop plate was loose in 1 case, the screw was not screwed in 2 cases, and the metal guidewire was not pulled out in 1 case. Of patients who suffered traumatic reinjury, 24 suffered high-power trauma, whereas 11 suffered low-power trauma. Graft relaxation occurred in 3 cases, and absorption was noted in 5 cases among graft failure patients. Joint instability resulted from multiple knee ligament injuries, along with medial and lateral collateral ligament damage. In cases of infection, knee joint infection occurred in 3 cases, while 1 case involved wound infection combined with bone tunnel lysis, and another case involved a knee joint infection emerging after the revision procedure.

ACLR failure is associated with traumatic reinjury, inappropriate tunnel placement, graft failure, graft fixation problems, infection, and multiple ligament injuries. Particular emphasis should be placed on the precise positioning of bone tunnels during surgical procedures. Proper manipulation of the aforementioned influencing factors is crucial to the success rate and therapeutic efficacy of arthroscopic ACLR.