The first step is understanding why the ACL graft has failed and identifying any other factors that may affect the success of further surgery.

Why do ACL reconstructions fail?

An ACL reconstruction may fail following another sporting or pivoting injury. Other factors can include the position of the previous reconstruction, meniscus damage adding to instability, persistent rotational instability due to other ligament injuries, or the anatomy and alignment of the knee.

Understanding the reason for failure is an important part of planning successful revision surgery.

Planning revision ACL surgery

Every revision ACL is different. Assessment may include MRI, X-rays including alignment assessment, or occasionally CT imaging.

Revision surgery is individually planned around your previous reconstruction, available graft options, knee anatomy, meniscus and cartilage health, and any other causes of instability.

The aim is to treat the whole knee rather than simply replace the ACL again.

This typically involves revision ACL reconstruction with additional procedures such as meniscus repair, other ligament repair or reconstruction, and anterolateral ligament (ALL) augmentation.

Success / Prognosis After Surgery

Compared with primary ACL surgery, revision ACL surgery and rehabilitation can be more challenging. Identifying why the previous ACL graft failed is key. When these contributing factors can be identified and addressed, outcomes after revision surgery can still be very good, with the goal of restoring a stable, functional knee.

Successful revision ACL surgery starts with understanding why the first reconstruction failed and developing the right plan for your knee.