Editorial Commentary: Suture Tape Augmentation for Revision Anterior Cruciate Ligament Reconstruction: Finding Ways to Improve on Previous Failures.

When a primary anterior cruciate ligament reconstruction fails, we look for something to do differently the second time around, and suture tape augmentation has increasingly become part of that conversation in revision surgery. There are several known risk factors for graft failure-younger age, higher activity level, smaller graft diameter, and increased tibial slope-but it remains unclear which patients, if any, would benefit from suture augmentation in the primary setting. Suture augmentation may well have a role in revision anterior cruciate ligament reconstruction, particularly for soft-tissue grafts prone to attritional failure, but many other considerations in the revision setting exist as well, such as improved tunnel placement, mechanical alignment, meniscal and concomitant ligamentous deficiencies, and the addition of a lateral extra-articular procedure. First and foremost, however, graft selection is a key challenge in revision anterior cruciate ligament reconstruction, particularly if prior ipsilateral autograft harvests have limited the selection pool. When soft-tissue autografts are used in revision surgery, a protective seatbelt with suture augmentation may make the difference in protecting against a repeat graft failure. However, controlling for the many confounders and concomitant procedures in the revision setting requires greater cohort sizes for adequate power, or a large, randomized trial. As such, if suture augmentation proves to have similar clinical outcomes and complication profiles but reduced retear rates, it may be worthwhile to implement it in the revision setting at this time.