How to repair an immediately post-operative anterior cruciate ligament reconstruction failure? About a clinical case

Joao Estves, Joao Maia Rosa, Luis Barros, Ana Ribau, Paulo Pereira, Adelio Vilaça


We present a 23-year-old male with an early anterior cruciate ligament (ACL) reconstruction failure due to lateral wall blow-out, diagnosed on day one post-op. We were able to perform the revision using the original graft, and maintaining the initial tibial fixation, revising only the femoral fixation. At 1-year follow-up the patient is asymptomatic. In the early ACL reconstruction failures due to femoral wall blowout, it is possible to perform the revision surgery using the same graft and maintaining the same tibial fixation. This avoids de morbidity of a new graft harvest and the need for a new tibial tunnel.


Anterior cruciate ligament reconstruction, Anterior cruciate ligament revision, Graft preservation, Wall-blowout

Full Text:



Almazan A, Miguel A, Odor A, Ibarra JC. Intraoperative incidents and complications in primary arthroscopic anterior cruciate ligament reconstruction. Arthroscopy. 2006;22:1211-7.

Herbort M, Heletta S, Raschke MJ, Schliemann B, Osada N, Petersen W, et al. Accidental Perforation of the Lateral Femoral Cortex in ACL Reconstruction: An Investigation of Mechanical Properties of Different Fixation Techniques. Arthroscopy. 2012;28:382–9.

Rue JP, Busam M, Detterline A, Bach B. Posterior Wall Blowout in Anterior Cruciate Ligament Reconstruction –Avoidance, Recognition, and Salvage. J Knee Surg. 2008;21:235–40.

Mitchell JJ, Chase SD, Jorge C, Travis JM, Tyler RC, Robert FL. Posterior Wall Blowout in Anterior Cruciate Ligament Reconstruction: A Review of Anatomic and Surgical Considerations. Orthop J Sports Med. 2016;4(6):2325967116652122.

George MS, Dunn WR, Spindler KP. Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 2006;34:2026-37.

Harner CD, Giffin JR, Dunteman RC, Annunziata CC, Friedman MJ. Evaluation and treatment of recurrent instability after anterior cruciate ligament reconstruction. Instr Course Lect. 2001;50:463-74.

Trojani C, Sbihi A, Djian P, Potel JF, Hulet C, Jouve F, et al. Causes for failure of ACL reconstruction and influence of meniscectomies after revision. Knee Surg Sports Traumatol Arthrosc. 2011;19:196-201.