Anterior Cruciate Ligament Reconstruction: Contemporary Revision Options

Rupture of the ACL is a common sports injury often managed with ligament reconstruction. Despite relatively high success rates, ACL graft failures do occur, providing frustration for the patient and presenting a challenge for the surgeon. Fortunately our understanding of ACL anatomy, biomechanics and reconstruction has increased dramatically in recent years. The challenge with revision ACL reconstruction begins with determining the reason for failure. Poor surgical technique with improper tunnel placement has been identified in a high proportion of failed reconstructions. Unlike primary reconstructions, additional variables including bone loss, retained hardware and concomitant meniscal, chondral and/or ligamentous injury are often present and must be addressed at the time of revision. This chapter provides an algorithm for the evaluation of patients with a failed ACL graft and guideline to revision ligament reconstruction.