Long-Term Failure of Anterior Cruciate Ligament Reconstruction

PurposeThe aim of this study was to review and describe the cumulative incidence of anterior cruciate ligament (ACL) graft rupture and/or clinical objective failures at greater than 10 years after ACL reconstruction.MethodsA PubMed search was performed to identify and systematically evaluate all studies performed between 1980 and 2012 with clinical outcomes after intra-articular, non-artificial ACL reconstruction and minimum 10-year follow-up. Studies reporting standardized surgical technique, ACL graft rupture, and objective International Knee Documentation Committee (IKDC) grade or ligament stability examination were included for analysis. After we first identified patients with graft rupture, clinical failure was further identified as 1 or more of the following: overall IKDC objective score of C or D, IKDC grade C or D pivot shift (i.e., >2+ or pivot shift), IKDC grade C or D Lachman examination, and/or abnormal KT arthrometer (MEDmetric, San Diego, CA) measurement (i.e., >5 mm). For this study, cumulative ACL failure rates were defined as the sum of both clinical failures and ACL graft ruptures.ResultsAfter review and exclusion of 625 references, 14 studies were identified for subsequent review. At longer than 10 years' clinical follow-up, the reported ACL graft rupture rate was 6.2% (173 of 2,782) (range, 0% to 13.4%) and clinical failure occurred in approximately 10.3% (158 of 1,532) (range, 1.9% to 25.6%). The overall cumulative ACL failure rate was 11.9% (range, 3.2% to 27%).ConclusionsAt least 1 in 9 patients undergoing ACL reconstruction will have rerupture or clinical failure at long-term follow-up.Level of EvidenceLevel IV, systematic review of Level II and IV studies.