Revision anterior cruciate ligament reconstruction

Anterior cruciate ligament (ACL) reconstruction has gained wide acceptance as the treatment of choice for the functionally unstable ACL-deficient knee and is now performed on about a half million individuals per year. The documented long-term good or excellent result rates for functional stability, relief of symptoms, and return to activity for intra-articular ACL reconstructions is approximately 75% to 95%. This leaves a substantial group of patients with an unsatisfactory result secondary to a variety of reasons. Review of the literature reveals that recurrent instability and graft failure are responsible for unsatisfactory results in as high as 8% of these patients. In this article, the factors responsible for graft failure and recurrent instability are discussed. In addition, the planning and difficulties that the orthopedic surgeon must address before, during, and after the procedure, are also reviewed.