Revision anterior cruciate ligament reconstruction: The hospital for special surgery experience

Primary anterior cruciate ligament (ACL) reconstruction continues to be one of the most common procedures performed in orthopedics, resulting in an increasing number of revision cases. Common reasons for primary failure include failure to identify coexistent medial or lateral injury and incorrect tunnel placement, most often involving the femoral side. Our approach to revision surgery involves identification of the mode of failure, meticulous preoperative planning and specific revision techniques to address retained hardware, bone tunnel defects, and incorrect tunnel placement. Results of revision surgery remain inferior to primary reconstruction, and should be regarded as a salvage procedure. However, with improving techniques, successful revision reconstruction can result in a stable knee with acceptable functional outcomes.