Most Frequent Causes of Autologous Graft Failure in Anterior Cruciate Ligament Replacement

Vališ, Petr; Sklenský, Jan; Repko, Martin; Rouchal, Marek; Novák, J; Otaševič, Tomáš

doi:10.55095/achot2014/051

Cited by 20 publications

(1 citation statement)

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“…Since BTPB autografts might be at lower risk for increased laxity, these graft types are subsequently more prone to other failure mechanisms. When reviewing the literature, Valis et al similarly reported new trauma as the most important failure mechanism of BTPB autografts [60]. Another reason that could contribute to this finding may be that BTPB grafts are more commonly used in high-demand athletes performing competitive sports, which increases the risk of graft rupture significantly [55,64].…”

Section: Discussionmentioning

confidence: 99%

Trauma and femoral tunnel position are the most common failure modes of anterior cruciate ligament reconstruction: a systematic review

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et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To improve outcomes of anterior cruciate ligament reconstruction (ACLR), it is important to understand the reasons for failure of this procedure. This systematic review was performed to identify current failure modes of ACLR. Methods A systematic search was performed using PubMed, EMBASE, Cochrane, and annual registries for ACLR failures. Studies were included when failure modes were reported (I) of ≥ 10 patients and (II) at a minimum of two-year followup. Modes of failure were also compared between different graft types and in femoral tunnel positions. Results This review included 24 cohort studies and 4 registry-based studies (1 level I, 1 level II, 10 level III, and 16 level IV studies). Overall, a total of 3657 failures were identified. The most common single failure mode of ACLR was new trauma (38%), followed by technical errors (22%), combined causes (i.e. multiple failure mechanisms; 19%), and biological failures (i.e. failure due to infection or laxity without traumatic or technical considerations; 8%). Technical causes also played a contributing role in 17% of all failures. Femoral tunnel malposition was the most common cause of technical failure (63%). When specifically looking at the bone-patellar tendon-bone (BPTB) or hamstring (HT) autografts, trauma was the most common failure mode in both, whereas biological failure was more pronounced in the HT group (4% vs. 22%, respectively). Technical errors were more common following transtibial as compared to anteromedial portal techniques (49% vs. 26%). Conclusion Trauma is the single leading cause of ACLR failure, followed by technical errors, and combined causes. Technical errors seemed to play a major or contributing role in large part of reported failures, with femoral tunnel malposition being the leading cause of failure. Trauma was also the most common failure mode in both BPTB and HT grafts. Technical errors were a more common failure mode following transtibial than anteromedial portal technique. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%