Together with my team of researchers, I have spent nearly three decades studying the causes of failure of knee ligament reconstructions and the outcome of revision operations using a variety of graft materials.
Of course, patients who have had an ACL reconstruction can accidentally re-injure their knee and tear the graft, but I have put this at the bottom of the list, as failure is more often due to factors over which the surgeon has control.
As we deal with patients who come to us for revision surgery, we determine the contribution of each of these elements to the failure of the primary procedure.
The tragedy is that the primary procedure offers the best chance to obtain a fully functional and stable knee, provided attention is paid to avoiding the first five of these factors. Once the patient has had surgery, and then struggled to rehabilitate in the face of non-optimal stability, then struggled again after failure of the repair, the whole situation becomes a great deal more complicated. The menisci take more stress and can become secondarily damaged. The joint surface becomes damaged and arthritis can become established. The muscles become weak. The bone stock becomes poor.
On top of all this one must remember that the surgeon has probably already harvested the most appropriate tendons to use for the replacement graft - now decisions about what graft material to use become more complicated.
I will go over each of these items in turn as we walk through the next few parts of this course.