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Why Do Second Knee Surgeries Fail? New Study

September 14, 2011

As part of a new study looking at why second ACL surgeries usually fail, 87 surgeons from across the nation, all of who are sports medicine specialists and American Orthopaedic Society for Sports Medicine members, are recruiting patients who’ve torn their ACL a second time.

They’re hoping to enlist about 1,000 patients.

A failed ACL surgery can lead to a condition called arthrofibrosis, which if left untreated will lead to post-traumatic arthritis.

Rick Wright, professor of orthopaedic surgery, co-chief of Washington University’s Sports Medicine Service and an orthopedic surgeon at Barnes-Jewish Hospital, is heading up the study. The study is one of the largest multi-center, orthopedic studies.
The Rate of ACL Surgery Failures

Over 200,000 ACL surgeries are performed every year. Out of those surgeries, about one to eight percent fail. If it’s a second ACL reconstruction, the rate doubles to fourteen percent.

That’s a disturbing jump. And it’s worth investigating to figure out why the rate of failure doubles because it’s not just athletes who risk a drop in the quality of life, namely the inability to play, but non-athletes, too, who need healthy knees to get their job done.

See, the ACL is crucial to a properly functioning knee. It’s responsible for our ability to jump, cut or change directions. And a torn ACL can also damage the meniscus–the cartilage-like, half-moon shaped disc that protects and stabilizes the knee during tension or torsion. The damage can lead to arthritis and eventual knee replacement.

There’s a lot at stake.

What Causes ACL Surgery Failure

Athletes are typical candidates for ACL surgery, but anyone in a blue collar job from construction workers to mechanics to waitresses to nurses can also damage their ACL. All it takes is a fall or a too much pressure on the knee and it gives.

Sometimes ACL surgeries fail because the procedure is done too soon following an injury. Other reasons include using devices that prevent the full extension of the knee, like post-surgery casts or braces.

Sometimes grafts are too tight and prohibit a full range of motion or the graft is simply misplaced. This can happen when two bone screws are used.

A poorly designed rehabilitation program or a lazy athlete can also lead to failure. More often than not, however, the failure is due to a blend of the above conditions.

But, most often, the cause of failure is a combination of the above.

Dr. Rick Lehman is a distinguished orthopedic surgeon in St. Louis, Missouri and an articular cartilage reconstruction pioneer He owns U. S. Sports Medicine in Kirkwood, MO, and LehmanHealth. Learn more about Dr. Rick.


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