Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic ReviewLong-Term Failure of Anterior Cruciate Ligament Reconstruction
Section snippets
Methods
A PubMed/Medline database search was performed in September 2011 and updated in December 2012 by use of the terms “anterior cruciate year follow” to evaluate failure rates of ACL reconstruction at greater than 10 years' follow-up. All citations were then screened by 2 investigators. Inclusion criteria required English-language publication, intra-articular allograft or autograft ACL reconstruction, consistent surgical technique, minimum 10-year follow-up, reported rerupture rate, and objective
Results
After screening 625 results, we selected 26 studies for full review. Twelve of these were excluded because of surgical technique,4, 5, 6 insufficient clinical follow-up,7, 8 absent or inadequate stability testing,9, 10, 11, 12 no reported rerupture rate,13 non–English-language publication,14 and inconsistent surgical technique.15
Discussion
This cumulative failure rate of primary ACL reconstruction may be higher than previously documented. Previous studies have focused on a limited description of failure after primary ACL reconstruction, reporting only on rates of ipsilateral ACL rerupture.30 However, a more inclusive definition of ACL failure should encompass patients with poor clinical outcomes as indicated by established objective clinical measures. In this systematic review of 14 studies, ACL rerupture occurred in an average
Conclusions
At least 1 in 9 patients undergoing ACL reconstruction will have rerupture or clinical failure at long-term follow-up.
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The authors report the following potential conflict of interest and sources of funding received in this article: J.H.L. is a consultant for Arthrex and Ivivi; paid speaker for DCI; receives royalties from Arthrex; holds stock in Ivivi; and has received research/institutional support from Arthrex, Breg, and Smith & Nephew.