Revision ACL Reconstruction

* There are multiple causes of failure following a primary anterior cruciate ligament (ACL) reconstruction. These include technical factors, patient sex, patient age, graft type, and others. * When performing a revision ACL reconstruction, the decision as to what graft to use should be made in conjunction with the patient, taking into consideration his or her activity level, sport of interest, and work or personal lifestyle. * In the setting of a revision ACL reconstruction, the risk of failure of an allograft is substantially higher than that of an autograft, especially in patients younger than 30 years of age. * The surgeon must determine whether to perform a single-stage or 2-stage revision when performing a revision ACL reconstruction. Two-stage revisions are rarely performed, but are particularly useful in the setting of substantial tunnel widening. * One of the most debated issues following revision ACL reconstruction is timing of return to sport. To our knowledge, no high-level evidence exists to guide surgeons in setting a definitive return-to-sport timeline for athletes. Hence, surgeons should evaluate each patient on an individual basis to determine when he or she is ready to return to sport.