Revision anterior cruciate ligament surgery - Preoperative evaluation and considerations

An orthopedic surgeon must carefully evaluate each patient before proceeding with revision anterior cruciate ligament (ACL) surgery. A concerted effort directed at delineating the reason(s) for failure of the primary reconstruction should be undertaken to prepare an orthopedic surgeon for revision ACL surgery. The evaluation should include a detailed history from the preoperative period of the primary ACL until the present. Physical examination should evaluate the knee for previous scars as well as associated laxity. Diagnostic studies should at a minimum include plain radiographs and magnetic resonance imaging. in addition, the operative surgeon should be experienced in ACL surgical techniques, have the appropriate tools and fixation devices, and have several graft choices. Finally, if there is any question about the ability to place the tunnels appropriately or obtain solid fixation, strong consideration should be given to staging the revision reconstruction.