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Tunnel malposition
90%
1491/1648
Obesity
0%
5/1648
Smoking
1%
19/1648
Returning to sport too early
5%
78/1648
Inadequate physical therapy
3%
47/1648
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Many factors may be involved in the failure of ACL reconstructions, including the surgical technique, the selection of graft material, the integrity of the secondary restraints, the condition of the articular and meniscal cartilage, postoperative rehabilitation, and the motivation and expectations of the patients. Early failure, usually within the first 6 months, most often is the result of technical errors, incorrect or overly aggressive rehabilitation, premature return to sports, or failure of graft incorporation. Later failure, usually after one year, is more typically the result of recurrent injury. The most avoidable and most common cause of failure is surgical technique. These errors include improper tunnel placement (most common), and errors in graft selection, size, physiognomy or tensioning. Anterior tunnels (most common) results in a graft tight in flexion and loose in extension. The Azar paper is an instructional course of revision ACL surgery. The Wolf paper and the Allen paper review both the causes for ACL graft failure and the planning steps needed to address them during revision reconstruction.
3.9
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