SynthesisInternational orthopaedics2023
Failure modes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.
Synthesis in International orthopaedics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Machine learning models predicting risk of revision or secondary knee injury after anterior cruciate ligament reconstruction demonstrate variable discriminatory and accuracy performance: a systematic review.BMC musculoskeletal disorders · 2025Pooled it
- Hamstring tendon graft with LARS augmentation showed superior short-term clinical efficacy compared to hamstring tendon alone as graft in ACL reconstruction: a systematic review and meta-analysis.Journal of orthopaedic surgery and research · 2024Pooled it
- Differences in the collagen of semitendinosus tendon in patients with and without general joint laxity.Bone & joint research · 2026Article
- Prevalence and risk factors of medial meniscal ramp lesions in patients undergoing primary anterior cruciate ligament reconstruction at a tertiary center.Journal of orthopaedic surgery and research · 2026Article
- Anterior Cruciate Ligament Reconstruction Failure: Etiology, Classification, and Revision Strategies-A Narrative Review.Journal of functional morphology and kinesiology · 2026Review
- Beyond the ACL: The Hidden Impact of Ramp Tears on Knee Stability.The archives of bone and joint surgery · 2026Review
- Image based three-dimensional kinematic mapping to optimize femoral tunnel placement for intra-articular cranial cruciate ligament reconstruction in dogs.Frontiers in veterinary science · 2026Article
- Augmenting an Allograft for Anterior Cruciate Ligament Reconstruction With a Collagen Matrix and Bone Marrow Aspirate Concentrate Injection Appears Safe and Produces Favorable Clinical Outcomes at 2-Year Follow-Up.Arthroscopy, sports medicine, and rehabilitation · 2025Article
- Five-year clinical study of a novel porcine xenograft for anterior cruciate ligament reconstruction: Positive safety and performance outcomes.Journal of experimental orthopaedics · 2025Article
- Optimal Tunnel Positioning and Graft Diameter to Minimize Impingement in Single-Bundle ACL Reconstruction: A 3D CT Simulation Analysis.Medicina (Kaunas, Lithuania) · 2025Article
- Anterior Cruciate Ligament Return to Play: "A Framework for Decision Making".Journal of clinical medicine · 2025Article
- Considerations in revision of anterior cruciate ligament reconstruction in the high-level athlete.Annals of joint · 2025Review
- One-stage revision anterior cruciate ligament reconstruction: Preoperative evaluation, planning and surgical techniques. A review of current concepts.Journal of experimental orthopaedics · 2025Review
- Modifiable and non-modifiable risk factors affecting surgical failure after revision ACL reconstruction: a cohort study.Knee surgery & related research · 2024Article
- Location of the Anatomic Footprint Centers of the Anterior Cruciate Ligament Determined by Quadrant Method on Three-Dimensional Magnetic Resonance Imaging.Indian journal of orthopaedics · 2024Article
- Effect of Different Screw Materials on ACL Reconstruction With the Tape Locking Screw Technique: A Retrospective Study From the FAST Cohort.Orthopaedic journal of sports medicine · 2024Article
- ACL surgery: reasons for failure and management.EFORT open reviews · 2023Review
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe reason for graft failure after anterior cruciate ligament reconstruction (ACLR) is multifactorial. Controversies remain regarding the predominant factor and incidence of failure aetiology in the literature. This review aimed to provide a meta-analysis of the literature to evaluate the relative proportion of various failure modes among patients with ACLR failure.
methodsThe PubMed, Embase, Cochrane Library, Web of Science, and EBSCO databases were searched for literature on ACLR failure or revision from 1975 to 2021. Data related to causes for ACLR surgical failure were extracted, and a random effects model was used to pool the results, which incorporates potential heterogeneity. Failure modes were compared between different populations, research methods, graft types, femoral portal techniques, and fixation methods by subgroup analysis or linear regression. Funnel plots were used to identify publication bias and small-study effects.
resultsA total of 39 studies were analyzed, including 33 cohort studies and six registry-based studies reporting 6578 failures. The results showed that among patients with ACLR failure or revision, traumatic reinjury was the most common failure mode with a rate of 40% (95% CI: 35-44%), followed by technical error (34%, 95% CI: 28-42%) and biological failure (11%, 95% CI: 7-15%). Femoral tunnel malposition was the most common cause of the technical error (29%, 95% CI: 18-41%), with more than two times higher occurrence than tibial tunnel malposition (11%, 95% CI: 6-16%). Traumatic reinjury was the most common factor for ACLR failure in European populations and in recent studies, while technical errors were more common in Asian populations, earlier studies, and surgery performed using the transtibial (TT) portal technique. Biological factors were more likely to result in ACLR failure in hamstring (HT) autografts compared to bone-patellar tendon-bone (BPTB) autografts.
conclusionTrauma is the most important factor leading to surgical failure or revision following ACLR. Technical error is also an important contributing factor, with femoral tunnel malposition being the leading cause of error resulting in failure.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.