Revision ACL Reconstructions

Failure of an ACL reconstruction may be attributed to surgical technical errors, a lack of biological incorporation of the graft, a new traumatic injury, failure to address patient anatomy or the inadequate treatment of associated injuries, including tears of secondary restraints in the anterolateral compartment of the knee. Unlike primary reconstruction, revision surgery must include careful preoperative planning, which could mainly include analysis of possible causes of failure of the previous operation to be eventually avoided in repeated surgery. Regardless of the graft used, tunnel placement and their possible expansion as well as the presence and location of the fixation devices are the most important factors to be considered. Avoiding the convergence or overlapping of the new tunnels with the previous tunnels could result in stronger fixation and faster incorporation of the graft. Fixation devices can be removed only if they actually interfere with the new tunnels, as their removal could result in significant bone loss and/or weakening of the implant site. As in primary reconstruction, the hamstrings represent our graft of choice in revision surgery. However, regardless of the selected graft, extraarticular reconstructions are strongly recommended to improve knee stability and reduce the rate of failure. Although the results of revision ACL surgery are good overall, they appear to be inferior to those of primary reconstruction in terms of patient satisfaction, knee stability, return to sports and early onset degenerative osteoarthritis.