Evidence map›Paper›PMID 41718205›Full record

ReviewJournal of functional morphology and kinesiology2026

Anterior Cruciate Ligament Reconstruction Failure: Etiology, Classification, and Revision Strategies-A Narrative Review.

Giacomo Capece, Rosario Junior Sagliocco, Guido Bocchino, Andrea De Fazio, Emidio Di Gialleonardo, Alessandro El Motassime, Davide Messina, Agostino Fernicola, Giulio Maccauro, Raffaele Vitiello

Abstract readReview
In one paragraph

Review in Journal of functional morphology and kinesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Giacomo CapeceU.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy.ORCID 0009-0000-9565-6691
Rosario Junior SaglioccoU.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy.ORCID 0009-0006-7860-8499
Guido BocchinoOrthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy.
Andrea De FazioOrthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy.ORCID 0000-0001-8321-532X
Emidio Di GialleonardoOrthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy.
Alessandro El MotassimeOrthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy.ORCID 0009-0001-8331-0826
Davide MessinaOrthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy.
Agostino FernicolaUnit of Emergency Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, 80134 Naples, Italy.ORCID 0000-0002-3122-5531
Giulio MaccauroOrthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy.
Raffaele VitielloOrthopaedics and Trauma Surgery Unit, Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy.ORCID 0000-0003-2321-9665

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure, but graft failure remains a significant complication, particularly in young and active individuals. Understanding the multifactorial etiology of failure and optimizing revision strategies are crucial for improving outcomes. A structured narrative review of the literature was conducted, including studies published from January 2000 to May 2024. Databases searched included PubMed/MEDLINE, Embase, and Google Scholar. Eligible studies addressed definitions, etiology, classification, and surgical management of ACL reconstruction failure. Data were synthesized qualitatively, integrating evidence on technical, biological, and traumatic causes, as well as neuromuscular and psychosocial factors influencing functional outcomes. ACL reconstruction failure is primarily caused by technical errors, particularly tunnel malposition (60-70% of cases), followed by traumatic (15-25%) and biological (10-15%) mechanisms. Failure timing provides diagnostic clues: early (<3 months) failures often relate to fixation or infection, mid-term (3-12 months) to technical errors, and late (>12 months) to trauma or degeneration. Revision strategies include individualized graft selection, anatomical tunnel placement, repair of associated lesions, and consideration of biomechanical abnormalities. Overall success rates of revision procedures average 70-75%, with lower outcomes in adolescents and high-demand athletes. Emerging techniques, including lateral extra-articular tenodesis and biologic augmentation, may enhance revision outcomes, although long-term evidence remains limited. ACL reconstruction failure is a multifactorial event requiring thorough preoperative assessment, precise surgical planning, and individualized management. Addressing technical, biological, and neuromuscular factors, alongside patient-specific considerations, is essential to optimize functional outcomes and reduce failure rates. Future research should focus on standardized reporting, multicenter prospective studies, and advanced surgical planning tools to further improve revision success.

Indexed as

ACL reconstructionbiomechanical factorsfunctional outcomesgraft failureneuromuscular controlrevision surgerytunnel malposition

Identifiers

PMID41718205
PMCPMC12938237

What OpenQuestion holds

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Registered trials

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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.