Analysis of different causes and risk factors of anterior cruciate ligament reconstruction failure

Abstract

BackgroundAnterior cruciate ligament (ACL) reconstruction failure is characterized by recurrent knee instability, stiffness, or pain that prevents a patient from participating in his or her chosen activities. The etiology of ACL reconstruction failure is multifactorial; surgical errors, infection, trauma, and/or associated pathology are blamed.AimThe purpose of this retrospective study was to define and analyze the causes of failure of ACL reconstruction.Patients and methodsThis study reviewed 300 patients who underwent ACL reconstructions, which were performed at Mansoura knee Surgery and Arthroscopy Unit over a 5-year period from 2005 to 2010. Untreated laxity, angular deformity, femoral and tibial tunnel malposition, method of fixation, and meniscus surgery were assessed; new trauma and infection were recorded. Assessment included knee stability tests, range of motion, and International Knee Documenting Committee scoring system evaluation.ResultsIn our study, the rate of ACL reconstruction failure was 7%. The main causes of failure were malpositioned tunnels (66.5%) and new trauma (24%). However, 15% of malpositioned tunnels caused failure and 50% of trauma caused failure. Moreover, 33% of infection, 5% of extracortical fixation, 2.2% of partial menisectomy, and 6% of preoperative varus knee were associated with failure.ConclusionMalpositioned tunnels and new trauma are the dominant causes of ACL reconstruction failure. Infection, extracortical fixation, partial menisectomy, and varus knee are risk factors for ACL reconstruction failure; thus, the failure is multifactorial.