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Why do ligament reconstructions fail?

Knee Surgeon Duncan Learminth

Dr (Mr) Duncan JA Learmonth

Knee Surgeon

DR (MR) DUNCAN JA LEARMONTH HAS RETIRED.Mr Duncan Learmonth is a renowned knee and shoulder surgeon who was based in Birmingham, UK.

October 1, 2023

Knee Surgeon, Duncan Learmonth, briefly explains why knee ligament reconstructions sometimes fail.

Not every cruciate ligament reconstruction is a success.

Cruciate ligament reconstructions may fail for several reasons -

  • Poor patient selection - some patients will 'hammer' their graft or not co-operate with rehab. They may be young, and if they want to return to high risk sports they need to know the risks and maybe attend a FIFA programme
  • Additional pathology, such as posterolateral corner laxity, medial collateral laxity, meniscal root injury, articular cartilage damage. Repair of a meniscal tear will hamper things because rehab needs to go slower with meniscal repair
  • Surgeon factors - tunnel position in the notch needs to be optimal
  • Graft type and thickness - autograft is best. Graft needs to be 8mm or more (but don't overstuff the notch)
  • Graft tensioning and fixation - tensioning is important (25-30 Newtons). Most modern fixation devices are acceptable, but the endobutton needs to be flush on the bone
  • ?Failure to preserve the ACL remnant - preserving the remnant may help in healing and proprioception