Introduction

The anterior cruciate ligament, or ACL, is one of the most important stabilisers in the knee, helping to keep it steady and functioning correctly. When this ligament suffers a serious injury, ACL reconstruction surgery is often recommended to restore stability and allow patients to return to their everyday activities or sports. However, it’s crucial to realise that the surgery itself is just one part of the journey — understanding the potential short- and long-term risks and complications that can occur afterwards is equally important.

As highlighted by Hasan (2023), “Although reconstruction is largely acknowledged as the gold standard treatment option for ACL injuries, many patients continue to have problems, including graft failure, inability to return to sporting activities, and the development of arthritis.” This article takes an honest look at these risks, explains why they happen, and offers advice on prevention and recognising early warning signs. It also shows how expert support — such as that offered by Professor Paul Lee and the MSK Doctors team — can make a real difference, even though outcomes can’t be guaranteed for every patient.

Early and Late Complications of ACL Surgery

After ACL reconstruction, some complications can happen quite soon, while others may only appear much later. Early post-surgery problems include infections (rare but serious), bleeding inside the joint, stiffness caused by scar tissue (known as arthrofibrosis), and damage to nearby nerves or blood vessels.

As recovery continues, longer-term issues might emerge, such as persistent knee pain, feelings of instability from graft problems, failure or rupture of the graft itself, fractures in the kneecap, or injuries to other parts of the knee that were missed initially. Hasan (2023) notes that “many patients continue to have problems, including graft failure… and the development of arthritis,” showing how some complications develop over time.

Another important factor is the risk of developing osteoarthritis following ACL surgery, which has prompted researchers to explore alternative treatments (Vavken & Murray, 2011). Thankfully, complications are much less likely when surgery is carried out by experienced surgeons in highly professional clinical settings, such as those at MSK Doctors , where patient safety is paramount.

What You Need to Know About ACL Graft Failure and Re-Injury Risk

When we talk about graft failure, we mean the reconstructed ligament failing to work as it should — this can happen if the graft does not heal properly or if it becomes damaged again, for example, due to returning too soon to intense physical activity. Despite ACL reconstruction being the leading treatment, “many patients continue to have problems, including graft failure” (Hasan, 2023). Reasons for this include incorrect rehabilitation, early return to sport, individual healing differences, and surgical technique issues.

It’s also worth knowing there are options if an initial repair doesn’t succeed. Fradin et al. (2021) explain that “One of the main advantages is that it leaves all grafts available for any type of reconstruction in case the repair fails.” This means that patients have options for further treatment while preserving tissue for future surgeries if needed.

Professor Paul Lee’s years of clinical experience ensure patients receive not only technically precise surgery but also personalised rehabilitation plans, which are essential to reducing the likelihood of graft failure and helping patients rebuild confidence in their knee .

Patient and Surgical Factors That Affect Risk

Every patient is different, and several personal factors influence the risk of problems after ACL surgery. Age, overall health, and activity levels are key considerations. For instance, younger, highly active individuals who participate in sports involving cutting and pivoting tend to face higher risks than older or less active patients.

Surgical choices also matter. Deciding between using your own tissue (autograft) or donor tissue (allograft) can impact healing and complication rates. Hasan (2023) highlights the recent “renewed interest in preserving ACL in order to avoid some of the consequences associated with its reconstruction,” pointing to possible benefits such as “decreased surgical morbidity, faster return of range of motion, and minimally invasive surgery .”

Vavken and Murray (2011) add that two big motivations for seeking alternatives to reconstruction are the “recently reported high rates of osteoarthritis after conventional ACL reconstruction” as well as challenges in treating younger patients whose bones are still growing safely. They also mention exciting advances in tissue engineering — “a bioactive and biocompatible scaffold which could be placed in the wound site to enhance cellular proliferation and biosynthesis…suggesting potential for a successful, future clinical application.” This kind of innovation could transform how ACL injuries are treated down the line.

These developments underscore the importance of getting support in a multidisciplinary clinic like MSK Doctors , where patient care is tailored to individual needs and the latest scientific advances.

How to Monitor, Prevent, and Achieve Realistic Outcomes

Careful monitoring after surgery is essential. Patients should keep an eye out for persistent or unusual pain , swelling, redness, warmth around the knee, instability, or difficulty moving the joint. If any of these occur, seeking prompt medical advice is crucial.

Following physiotherapy programmes and attending follow-up appointments is just as important in helping the knee heal properly and the graft last longer. Although many ACL grafts function well for years, some people experience ongoing problems. Hasan (2023) points out that encouraging new techniques — such as primary ACL repair — are being investigated to improve results and lessen complications. Working with experienced professionals such as Professor Paul Lee and the MSK Doctors team remains one of the best ways to enhance the chance of a strong, lasting recovery.

Conclusion and Important Disclaimer

ACL reconstruction remains a trusted and effective way to restore knee stability after injury, but it is essential to be aware of the possible early and late complications involved. Making informed decisions, understanding personal risks, and staying supported by skilled clinicians significantly reduce potential problems and help patients achieve better outcomes.

For personalised medical advice tailored to your situation, please consult a qualified healthcare professional.

References

Fradin, T., Haidar, I., Rayes, J., Ngbilo, C., Dutra Vieira, T., & Sonnery‐Cottet, B. (2021). Arthroscopic ACL Reconstruction After Failed ACL Repair. Arthroscopy Techniques, 10(4), e1001-e1005. https://doi.org/10.1016/j.eats.2020.11.022

Hasan, J. (2023). Primary ACL Repair. Orthopaedic Journal of Sports Medicine, 11(2_suppl). https://doi.org/10.1177/2325967121s00863

Vavken, P., & Murray, M. M. (2011). The Potential for Primary Repair of the ACL. Sports Medicine and Arthroscopy Review, 19(1), 44-49. https://doi.org/10.1097/jsa.0b013e3182095e5d