Why grafts fail.

Significant advances in anterior cruciate ligament reconstructive surgery have been made in the past decade and, as a result, the number of anterior cruciate ligament reconstructive procedures being done have increased. Unfortunately, graft failure continues to occur and has resulted in an emphasis on revision surgery. Successful anterior cruciate ligament reconstruction is dependent on a number of factors including: patient selection, surgical technique, postoperative rehabilitation, and associated secondary restraint ligamentous instability. A particular emphasis both in scientific and clinical research has been placed on surgical technique. Errors in graft selection, tunnel placement, tensioning, or fixation methods chosen may lead to graft failure. Improper postoperative rehabilitation may lead to graft failure; however, current protocols seem to minimize its occurrence. Finally, failure to recognize or treat a significant secondary restraint instability can place excessive stress on the anterior cruciate ligament graft which may lead to failure. Care must be taken at every step of the process to ensure graft failure does not occur, because revision anterior cruciate ligament surgery results are not as predictable as primary anterior cruciate ligament reconstruction.