Patient-related risk factors for ACL graft failure

Anterior cruciate ligament tears are a devastating injury to athletes commonly encountered in pivoting and cutting sports. Reconstruction of the ACL is generally performed to restore stability and return the athlete to a healthy and active lifestyle. Numerous risk factors for primary ACL tear have been identified including sex, activity level, anatomic variables, and neuromuscular control. ACL graft failure has been related to poor surgical technique, trauma, failure of biological incorporation, graft type, infection, and undiagnosed concurrent knee injury. There has been limited investigation, however, into patient-related risk factors for re-tear of grafts following ACL reconstruction. An understanding of these risk factors would enable clinicians to better counsel patients on their expected outcomes. This chapter reviews activity level, sex, age, biomechanical factors, and neuromuscular control as risk factors for graft failure after primary ACL reconstruction. Activity level and age have been shown to be significant risk factors for re-tear of ACL grafts. Athletes returning to high-level pivoting and cutting sports should be counseled on the increased risk of graft failure.