Abstract
Anterior cruciate ligament (ACL) reconstruction has gained wide acceptance as the treatment of choice for the functionally unstable ACL-deficient knee. Long-term good or excellent results of primary ACL reconstructions with respect to functional stability, relief of symptoms, and return to activity is between 75% and 95%. As much as 8% of the unsatisfactory results after primary ACL reconstructions are secondary to recurrent instability and graft failure. Failed ACL reconstruction with recurrent instability can be classified into the following three categories based on the primary reason for failure: technical errors, biological failure, and traumatic failure. These causes of failure are not mutually exclusive, and more than one may contribute to failure. Technical reasons are the most common cause of failure, and anterior femoral tunnel placement is by far the most prevalent cause of graft failure and recurrent instability after ACL reconstruction. This article reviews the possible causes of recurrent instability after ACL reconstruction to enable the surgeon to thoroughly delineate the cause of failure before proceeding with revision ACL surgery.
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