Revision Anterior Cruciate Ligament Reconstruction
There are significant technical differences between primary and revision anterior cruciate ligament (ACL) reconstruction which result in revision ACL reconstruction being a far more demanding procedure with increased risk for failure and the need for additional preoperative planning. Preoperative planning for revision ACL reconstruction is driven by the primary ACL reconstruction, patient factors, and determining the reason for failure of the primary ACL reconstruction. Advanced imaging, including MRI, CT, and CT with three-dimensional reconstruction, has become the cornerstone for preoperative planning in revision ACL reconstruction. The REVISE classification has been developed and can be used to guide one-stage versus two-stage revision planning. To reduce stress on the ACL graft in the revision setting, the patient undergoing revision ACL reconstruction may need additional procedures including osteotomy, lateral extra-articular tenodesis, or two-stage ACL reconstruction to allow for bone grafting. In performing revision ACL reconstruction, anatomic ACL reconstruction is paramount to restoring rotatory stability of the knee. Treatment and rehabilitation protocol should be tailored to the patient, and careful return to sport should occur after the patient has passed sport-specific psychomotor testing. This chapter reviews revision ACL reconstruction including preoperative planning, surgical techniques, pitfalls, and outcomes.
