This course by Frank Noyes MD covers the issue of why an anterior cruciate ligament (ACL) reconstruction might fail, and what options remain for a patient when this happens.

If the procedure is re-done, then that is called a ' revision '. Dr Noyes is one of the world's foremost knee surgeons, researcher and author of hundreds of leading publications on many many topics to do with the knee.


What happens to an ACL graft after implantation?

Surgical choices for the initial ACL reconstruction

What constitutes ACL graft failure and how do you measure it?

Causes of ACL graft failure

Compounding problems that must be addressed in revision ACL surgery

Graft options in revision ACL

  • allograft
  • ligament augmentation devices
  • synthetic grafts
  • autograft

Contraindications to ACL revision

  • partial function of a prior ACL reconstruction
  • No symptoms (pain,swelling, giving way ) in a patient who does not participate in strenuous or high risk activities
  • Prior joint infection
  • Obesity ( body mass index >30)
  • Bowed legs where the patient refuses to undergo a high tibial osteotomy before or with the ACL revision reconstruction
  • Severe muscle atrophy (wasting)
  • Poor patient motivation or expectations
  • Knee arthrofibrosis
  • Deficiency of the posterolateral structures where the patient refuses to undergo an associated posterolateral reconstruction with the ACL revision.

What can one expect after ACL revision?

  • Outcomes