FAILURE OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION - THE BIOLOGIC BASIS

The replacement tissue used for anterior cruciate ligament reconstruct ion undergoes extensive biologic remodeling and incorporation after im plantation, Successful biologic incorporation of the graft is dependen t on a number of factors including graft placement, tensioning, and th e nature of the tissue (allograft versus autograft), Failure of an ant erior cruciate ligament reconstruction may occur on the basis of eithe r technical, mechanical, or biological factors, Biologic factors inclu de cellular repopulation, matrix remodeling, the ultimate small diamet er collagen fibril orientation, the final cross sectional area of the graft, a favorable vascularization, and not overloading the graft duri ng the remodeling process, The fully incorporated graft never duplicat es the native anterior cruciate ligament but works as a check reign th at makes the knee more functional.