Revision anterior cruciate ligament reconstruction and additional surgeries: A review.

Anterior cruciate ligament (ACL) failure is caused by medical and nonmedical factors. A thorough preoperative evaluation should include knowledge of previous injuries, physical examination, and imaging. Classic tunnel management techniques include divergent drilling technique, transtibial technique, anteromedial portal technique, outside-in technique, and over-the-top technique. Although critical tunnel widening or overlap usually requires 2-stage revision ACL reconstruction (ACLR), efforts have been made to perform 1-stage revision ACLR in these cases. Bone grafts include bone autografts and bone allografts, synthetic bone grafts, and biologics. Grafts include autografts, allografts, and artificial ligaments. Extra-articular augmentation benefits revision ACLR in selected individuals. Varus knee and excessive posterior tibial slope should be addressed in some cases. Meniscus injury and articular cartilage injury should be addressed. Although the overall outcomes of revision ACLR are worse than those of primary ACLR, revision ACLR remains important for improving knee function and return to sport. Future research should expand the indications for 1-stage revision, clarify the indications of anterior closing wedge high tibial osteotomy and extra-articular augmentation at the time of revision ACLR, based on strong evidence.