A comprehensive technical review of revision ACL reconstruction addressing why primary reconstructions fail, how to evaluate and plan revision surgery, and what outcomes patients should expect. Covers failure classification, graft selection, hardware management, tunnel placement strategy, and associated instability patterns.
When evaluating a failed ACL reconstruction, systematically work through the four failure categories (technical, biologic, traumatic, secondary restraint) before planning revision — tunnel malposition is the culprit most of the time, but an unrecognized posterolateral corner injury will doom even a perfectly placed revision graft.
Counsel patients preoperatively that revision is a salvage operation: the goal is stable activities of daily living, not a guaranteed return to sport.
A comprehensive technical review of revision ACL reconstruction addressing why primary reconstructions fail, how to evaluate and plan revision surgery, and what outcomes patients should expect. Covers failure classification, graft selection, hardware management, tunnel placement strategy, and associated instability patterns.
When evaluating a failed ACL reconstruction, systematically work through the four failure categories (technical, biologic, traumatic, secondary restraint) before planning revision — tunnel malposition is the culprit most of the time, but an unrecognized posterolateral corner injury will doom even a perfectly placed revision graft.
Counsel patients preoperatively that revision is a salvage operation: the goal is stable activities of daily living, not a guaranteed return to sport.