Failed anterior cruciate ligament surgery in the middle age arthritic knee

Jim Gardiner, Tim Wilson, Darren L. Johnson

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Middle age patients who have failed anterior cruciate reconstruction and develop osteoarthritis present a significant challenge in orthopedic surgery. A clear understanding of the patient's symptoms must be obtained. Patients being considered for revision surgery should be well motivated, demonstrate increased anterior laxity on physical examination, and suffer from instability with activities of daily living. The etiology of failure can be established by a through history and physical examination, as well as appropriate radiologic studies. Poor outcome following ACL reconstruction may be caused by loss of motion, extensor mechanism dysfunction, arthritis of graft failure. The most common errors in surgical technique leading to recurrent laxity are nonanatomic tunnel position and failure to address associated instabilities. Technically successful revision depends on appropriate graft selection, hardware removal, anatomic tunnel positioning and correction of associated instabilities and skeletal mal-alignment. Results of revision ACL surgery may be inferior to those of primary reconstruction. The outcome is largely dependent on the integrity of the meniscal and articular cartilage. In the middle age patient with ostheoarthritis of the knee, revision ACL surgery should be considered a salvage procedure whose primary goal is restoration of stability with activities of daily living.

Original languageEnglish
Pages (from-to)129-139
Number of pages11
JournalSports Medicine and Arthroscopy Review
Issue number2
StatePublished - 2003


  • Anterior cruciate ligament
  • Arthroscopic reconstruction
  • Knee instability
  • Osteoarthritis
  • Revision

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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