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Evaluation and Treatment of Recurrent Instability After Anterior Cruciate Ligament Reconstruction*

Christopher D. Harner, M.D., J. Robert Giffin, M.D.F.R.C.S.(C), Roger C. Dunteman, M.D., Christopher C. Annunziata, M.D. and Marc J. Friedman, M.D.

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
*Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2001 in Instructional Course Lectures, Volume 50. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
Center for Sports Medicine, 3200 South Water Street, Pittsburgh, Pennsylvania 15203.
§Southern California Orthopaedic Institute, 6815 Noble Avenue, Van Nuys, California 91405.

	Introduction

 
The annual incidence of anterior cruciate ligament injuries in the United States has been estimated to be one in 3000 Americans¹. Reconstruction is now widely accepted as the treatment of choice for the patient with a functionally unstable anterior cruciate ligament-deficient knee. By current estimates, more than 100,000 anterior cruciate ligament reconstructions are performed annually in the United States². The long-term rates of good and excellent results, in terms of functional stability, relief of symptoms, and return to preinjury level of activity, have been reported to be between 75 and 90 percent^3-9. This, however, leaves a substantial group of patients who have an unsatisfactory result from the procedure because of a number of different causes. We will discuss the potential mechanisms of failure of primary intra-articular anterior cruciate ligament reconstruction and will provide the treating orthopaedist with a systematic approach for the evaluation of these difficult cases.

	Etiology of Failed Anterior Cruciate Ligament Reconstruction

 
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