Failed anterior cruciate ligament reconstruction and loss of motion

More than 60,000 people in the United States undergo primary anterior cruciate ligament (ACL) reconstruction each year. Although this procedure has a high clinical success rate, some patients experience poor outcomes due to recurrent instability, persistent pain, and loss of motion. In evaluating a patient with a failed ACL and loss of motion the surgeon first needs to identify the cause of failure. The most common causes include inaccurate tunnel placement and arthrofibrosis. Initial treatment is nonoperative, using physical therapy, splints, and pharmacotherapy. If these measures fail operative intervention is indicated. The surgeon should follow a step-wise treatment protocol that begins with a gentle closed manipulation and progresses to a percutaneous and arthroscopic lysis of adhesions, and in some cases open debridement. If the graft has failed, or needs to be released as part of the treatment, it is critical to regain knee motion prior to performing a revision ACL reconstruction. Postoperatively, an appropriately aggressive rehabilitation program will help to prevent a recurrence of motion loss.