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Surgical revision of a failed ACL reconstruction requires
thorough preoperative planning and evaluation of the factors
that may have caused the failure so that the correction of these
problems may be addressed during the revision operation. This
should include a thorough history, a physical examination and
a standard radiographic examination to evaluate the orientation
of the tunnels and their possible enlargement, and the type of
preexisting fixation devices.
The most common etiologic factor of ACL failure is an
error in surgical technique: an improper intra-articular
placement of the graft; impingement of the graft in the
intercondylar notch due to an insufficient notchplasty or due
to an anteriorly placed tibial tunnel; an improper tension of the
graft or inadequate graft fixation. Other causes of ACL failure
are infections, a new knee injury or recurrent swelling
following the use of prosthetic ligament in the primary
MRI permits direct evaluation of ACL graft, bone tunnels,
and additional disorders of the knee. Recognizing the
appearance not only of complications, but also of the
asymptomatic findings after ACL reconstruction is essential
for the radiologist and the clinician.
It is clear that the management of ACL injuries is
complex and continues to evolve Surgical techniques of ACL
reconstruction require proper placement and tensioning,avoidance of impingement and stress risers on the implanted
tissue, and adequate fixation.
The ideal graft for ACL reconstruction should have
biomechanical properties similar to those of the native ACL,
enable stable initial fixation and rapid biologic incorporation,
and offer a low rate of morbidity.
Anatomic double bundle ACL reconstruction is
technically demanding, but provides better restoration of
normal knee anatomy and kinematics than does single bundle