I need a little honesty here. I had an ACL reconstruction surgery that failed. The graft just ruptured one day and my leg went out from underneath me. No one seems willing (or able?) to tell me why this happened. I will have another surgery to fix the problem but I’d like to avoid this if there’s something I did wrong. And to be honest, if it’s some kind of pilot error, I’ll be shopping around for a different surgeon. How can I figure this out?

It’s possible that no one knows why it happened. Sometimes the surgeon can offer a better explanation after going back in and seeing what’s going on with the graft site and graft material. There certainly are both patient-related and surgeon-driven reasons why ACL reconstruction surgery fails.

For example, what happens on the patient side? Going back to demanding sports activities too soon is one potential error on the part of the patient. Overly aggressive rehabilitation can set the patient back. Too often the patient pushes past the guidance offered by the physical therapist. “More is better” is not the best motto during ACL reconstruction rehab. On the other side of the coin, too little rehab (poor patient compliance) can also contribute to a failed ACL reconstruction.

Surgeons play a role in the success or failure of ACL reconstruction. Poor graft placement, surgical contamination leading to infection, or other poor operative techniques can spell disaster. Putting the graft in the proper anatomical place but with too much or too little tension is another potential surgeon-related error.

There may be anatomical reasons out of the control of patient or surgeon such as quadriceps muscle dysfunction (muscle doesn’t contract the way it’s supposed to). Damage to other soft tissues in and around the joint that have not been identified yet can contribute to graft failures. If you have generalized ligamentous laxity or repeated trauma to the graft, the end result can be the same: graft failure.

You can certainly ask your surgeon and your physical therapist what they think happened. Be prepared to hear you may be part of the problem. More than likely it’s not anyone’s fault and a series of multiple factors were at play here. Certainly, once the surgeon scopes the knee (looks inside), some of the causes may become more obvious.