Why ACL Reconstructions Fail: Dr Ashwani Maichand Elaborates on Key Causes of ACL Repair Failure and How to Avoid Them
Anterior Cruciate Ligament (ACL) injuries are among the most common knee injuries, particularly in young and active individuals. ACL surgery is a common procedure to repair the torn ligament, and overall, it is a highly successful operation. With innovative techniques and surgical advancements, it is possible to precisely rebuild the anatomy and function of the original ACL. Yet, one of the common challenges of ACL injuries is the increasing number of patients who undergo repeated ACL tears, even after reconstruction surgery. According to renowned orthopaedic surgeon Dr. Ashwani Maichand, the reasons behind these failures are often avoidable when properly identified and addressed.
“ACL reconstruction does not fail by chance,” says Dr. Maichand. “There are clear reasons right from surgical technique to bone anatomy that can predispose a patient to repeated injury.”
Dr. Maichand recounts the various causes of ACL surgery failure including re-injury and premature return to sport, technical and surgical errors, biological and patient factors. Dr. Maichand explains that it is very important to wait before you return to high-impact activities and sports after surgery as the graft needs time to heal and regain strength. Additionally, one leading cause of recurrent tears is the anatomy or the tibial slope, that is the angle of the upper shin bone. In some patients, the slope is quite steep causing the tibia to slide forward excessively and putting abnormal stress on the ACL. “If the slope remains uncorrected,” he notes, “the reconstructed ligament continues to face undue strain, increasing the risk of re-tear.”
He cites real-world examples where patients underwent ACL reconstruction without addressing structural issues. “In one case, the patient’s first surgery failed because the tibial slope was too steep. We first had to correct that slope. Once the patient healed, we performed bone grafting because the previous tunnel had widened. Only after the graft healed could we plan a proper, stable ACL reconstruction.”
Tunnel widening is another commonly overlooked factor. When the previous ACL tunnel expands or is incorrectly positioned, the graft cannot anchor properly, leading to instability and eventual failure. Bone grafting becomes essential before attempting a revision ACL.
Dr. Maichand emphasizes that success begins before the surgery, with a detailed evaluation of bone shape, alignment, tunnels, and joint stability.
“Whenever we plan ACL reconstruction, we thoroughly assess the bones and knee anatomy. This ensures the reconstruction is done right the first time, reducing the risk of future tears.”
He also urges patients not to rush into revision surgeries without proper assessment. “Each knee is different. Understanding why the previous surgery failed is crucial. Only then can we create a strong, long-lasting solution.”
With advancements in diagnostics, imaging, and surgical planning, Dr. Maichand believes most repeat ACL failures can be prevented. “The goal is simple: restore stability, protect the joint, and allow patients to return to their active lives confidently.”
About Dr. Ashwani Maichand
Dr. Ashwani Maichand is a leading orthopaedic surgeon specializing in joint preservation, knee injuries, sports medicine, and complex revision surgeries. Known for his patient-centric approach and expertise in advanced joint procedures, he has helped thousands regain mobility and return to active lifestyles.