WHY GRAFTS FAIL

Significant advances in anterior cruciate ligament reconstructive surg ery have been made in the past decade and, as a result, the number of anterior cruciate ligament reconstructive procedures being done have i ncreased. Unfortunately, graft failure continues to occur and has resu lted in an emphasis on revision surgery. Successful anterior cruciate ligament reconstruction is dependent on a number of factors including: patient selection, surgical technique, postoperative rehabilitation, and associated secondary restraint ligamentous instability. A particul ar emphasis both in scientific and clinical research has been placed o n surgical technique. Errors in graft selection, tunnel placement, ten sioning, or fixation methods chosen may lead to graft failure. Imprope r postoperative rehabilitation may lead to graft failure; however, cur rent protocols seem to minimize its occurrence. Finally, failure to re cognize or treat a significant secondary restraint instability can pla ce excessive stress on the anterior cruciate ligament graft which may lead to failure. Care must be taken at every step of the process to en sure graft failure does not occur, because revision anterior cruciate ligament surgery results are not as predictable as primary anterior cr uciate ligament reconstruction.