Revision anterior cruciate ligament reconstruction

More than 100,000 anterior cruciate ligament (ACL) reconstructions are performed annually in the United States. The rates of good or excellent long-term results in terms of restoration of stability, relief of pain, elimination of "giving way" symptoms, and return to preinjury level of function were reported to be between 75% and 90%. ACL surgery continues to be refined with the application of knowledge gained from basic science and clinical research. Despite technique and treatment advancements, the current methods of reconstruction are far from perfect; a significant number of patients have an unsatisfactory postoperative outcome. This article discusses the multiple mechanisms of failure of primary intra-articular ACL reconstruction and provides the orthopaedic surgeon with a systematic approach to the evaluation and treatment of failed ACL reconstructions.