Revision anterior cruciate ligament reconstruction

Revision anterior cruciate ligament (ACL) surgery is more complex than primary reconstruction. The diagnosis of ACL graft failure can be made with a careful history, physical examination and the use of appropriate imaging studies. The etiology of the failure should be determined and includes tunnel malposition, traumatic failure, failure to treat incompetent secondary stabilizers and malalignment. The preoperative evaluation can identify associated pathology, tunnel malposition or widening and malalignment. The goal of revision surgery is to create anatomic tunnels with secure graft fixation. Two-stage revision with initial bone grafting may be needed if tunnel widening is present. Recent reports describe double-bundle augmentation of a vertical ACL graft. Although good outcomes can be achieved with revision ACL reconstruction, results are generally inferior to primary ACL reconstruction.