What Causes an ACL Reconstruction to Fail?
A poorly positioned ACL graft from the original surgical procedure is the most common cause of a failed reconstruction. A patient may also experience a re-tear of the ligament from not following rehabilitation guidelines, returning to athletic activities too quickly, or from new trauma to the ligament. Malalignment of a lower extremity, such as knocked knees or bow leggedness, may cause a failed reconstruction due to the knees experiencing uneven stress loads because of poor leg alignment.
When to have Revision ACL Surgery
If a knee revision surgery is necessary, Dr. Provencher will examine the injured joint in great detail to determine the exact cause of failure. By determining the cause of a failed ACL reconstruction, he can help eliminate the risk of a second failed procedure. New diagnostic testing images will be performed to determine the quality of bone and soft tissue structures within the knee joint.
Dr. Provencher typically performs a revision ACL reconstruction immediately following a re-tear in order to return full function, mobility, and stability to the joint. Much like primary (first intervention) ACL surgery, an allograft (donor tissue) or autograft (tissue harvested from the patient) will be utilized to perform the reconstruction of the damaged ligament. Dr. Provencher will determine the correct graft type based on previous graft choice.
How is Revision ACL Surgery Performed
If a patient experiences loss of bone quality after the original treatment, Dr. Provencher may need to perform a staged knee revision surgery. A staged procedure involves Dr. Provencher performing a bone grafting procedure to fill damaged areas with new bone, followed by a revision ACL reconstruction 4-6 months later. Patients with a malalignment of the lower extremity are also treated with a staged procedure in many cases.
It is important to note that an ACL reconstruction is very successful in most patients. A revision ACL reconstruction is also very successful but less so than the original surgery. This is due to the revision procedure and re-tear of the ligament.