ACL injuries occur frequently among athletes and non-athletes. It is estimated that there are over 100,000 ACL reconstruction surgeries each year in the United States. In most cases, there is between an 80-90% success rate for ACL surgeries. However, in a few rare cases, ACL reconstructions fail.
Pain after an ACL surgery requires careful evaluation, and may result from ACL graft failure. In general, a failed ACL surgery can occur for multiple reasons, and treatment to correct this failure is often complex and technically challenging for the surgeon.
Following ACL reconstruction, and after appropriate time and healing has passed, patients who still complain of instability, knee pain, limited range of motion, and knee stiffness are often the ones who experience a failed reconstruction. If the failure occurred within 3-6 months following the initial reconstruction, the failure was either due to surgical technique, graft failure, or a rehabilitation program that was too aggressive. Failures that occur later (6 or more months following surgery), are usually due to a newly developed injury.
If it is believed that a failed ACL reconstruction is causing the pain and instability, will carefully identify this problem through a thorough exam, full patient history, physical exam, x-rays and an MRI will be conducted. The goal will be to determine the cause of failure, and to plan a surgery revision technique that will lower the risk of a second failure.
Every situation and patient is different. Your physician will devise a tailored plan and approach for each patient. Treatment for a failed ACL may require staged procedures, and could involve removing old fixation devices, and possibly bone grafting to correct widened or poorly positioned bone tunnels or sockets. In some cases, a realignment may be necessary so that the knee is in alignment with the rest of the lower body. A revision surgery will most likely use an allograft, and frequently requires repair or reconstruction of other structures including other loose ligaments.
Following revision surgery, a 6 to 12 month rehabilitation process will ensue. Full weight bearing is sometimes delayed, and a return to certain activities and sports may be longer than after the initial surgery.
Revised ACL reconstruction surgery is something that takes precise planning, and careful evaluation. It is critical to understand the exact cause of the ACL failure for success in the future. The revision process requires a strong partnership between the patient and your physician, so that every step taken is a step towards a successful recovery.