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Forum Name: Joint surgery

Question: Failing 25-year-old ACL repair


 MochasMom - Tue May 19, 2009 6:44 pm

25 years ago I suffered a Grade III ACL rupture, which was simply repaired (sutured back together). It has been fairly good up until recently, I am now having posterior pain walking downhill, pain medially and laterally at or around the kneecap (at the points where the ACL connects to the tibia/femur), pain even at rest, mild swelling and increased pain after activity, and have had a positive Lachman's test showing laxity at 30 and 15 degrees particularly. I experience spontaneous hyperextensions, but have not yet had it 'give way' forward. I am scheduled for an MRI. X-rays show nothing unusual.

There was no significant trauma that brought on this recent pain/laxity, it seems to have gradually become worse over the years, particularly over the last 6-8 months. I am very active physically (Golf, curling, running)

My question is: does the ACL when repaired such as mine was, gradually degrade/stretch/tear over time and eventually fail, or is a tear always a result of a trauma? How likely is it that the ACL is either partially or completely torn? If there is a partial tear, will that be evident on the MRI?
 Tom Plamondon PA-C - Mon Jun 15, 2009 9:01 pm

User avatar Hello,
The ACL should hold up pretty well under normal stress and strain of daily activities including sports.
The duration of tautness may depend on the graft itself (autograft vs allograft) and the level and demand on the knee. Most athletes however do well for years with ACL reconstruction without appreciable laxity.

Since the ACL in your case was not replaced but repaired it may tend to stretch or fail sooner than if a new graft was sutured in.

A partial tear may be evident on MRI depending on its thickness and swelling. Clinical signs of laxity are just as helpful.

Hope this helps. Take care.

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