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Re-Tears of Anterior Cruciate Ligament (ACL)


A successfully reconstructed ACL can be just as strong or even more robust than a native ACL, but just as a patient’s original ACL can tear, a reconstructed ACL can retear as well. An ACL retear can occur simply due to “bad luck” in someone who returns to high-risk sports. But many times, reinjuries arise as a result of preventable problems associated with the original surgery. The two most common causes for ACL reconstruction failure are number one; returning to sports prematurely before fully rehabilitating and, number two, technical errors in surgery. When ACL graft failure occurs soon after surgery, this is usually due to a patient returning to sports before being cleared to do so, before they have fully regained their muscle strength and coordination. Patients can avoid these types of reinjuries by being complaint and only returning to sports once cleared by their surgeon after fully completing the rehabilitation process. Failures that occur later on are usually due to surgical errors. The most common surgical mistakes include incorrect bone tunnel placement, poor graft fixation, and failure to tension the graft properly. Clinical follow-up studies also show that graft choice may play a role and that allograft ligaments tend to fail more often than autograft ligaments, particularly in younger individuals.

ACL retears can be treated with revision anterior cruciate ligament (ACL) reconstruction surgery. Generally, the results of ACL revision surgery tend to be not quite as good as first-time ACL reconstruction, thus the importance of “getting it right” the first time. However, some patients can return to high-level physical performance, as demonstrated by many professional athletes who have returned to play after revision surgery. Being treated by a surgeon who has experience with complex ligament reconstruction will increase the likelihood of a more favorable outcome. Revision ACL reconstruction surgery is complicated and requires careful preoperative planning to anticipate and address many challenges that may arise in the operating room. Common issues to deal with at the time of revision include prior hardware such as screws and bone anchors, previously undiagnosed concomitant ligament injury, and bone loss associated with previous tunnel placement. The surgeon needs to consider available graft options, particularly if autograft was harvested at the first procedure. Revision surgery may require hardware removal, correction of other ligament injuries, restoration of bony alignment, and bone grafting of structural defects. The surgeon may need to harvest tendon grafts from the same knee or the opposite knee if available. If multiple ligaments require reconstruction, the surgeon may need to use allograft tissue. ACL revision surgery may be performed as a single procedure or require two separately staged surgeries for more complicated cases. And as with first-time ACL surgery, proper rehabilitation is of paramount importance after revision surgery.

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I recieved Regenerative Injection Therapy on my right hip back in early March, 2018 from Dr. Meier. The result thus far have been very good - I have less pain and much better mobility. Dr. Meier and his staff are true professionals and have been great at setting expectations for the potential results of the Regenerative Injection Therapy process, making sure all my questions are answered in detail both before and after the procedure. I highly recommend Dr. Meier to anyone looking for alternatives to a hip replacement.

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