Evaluation of the failed ACL reconstruction

There are many factors that may be involved in the failure of an ACL reconstruction. These factors include surgical technique and timing, graft material and incorporation, the integrity of the secondary restraints, postoperative rehabilitation, and selection of the patient including patient expectations. The goals of revision ACL surgery are to stabilize the knee, prevent further injury to the articular cartilage and menisci, and maximize the patient's function. Successful revision ACL surgery requires a thorough preoperative evaluation, including a detailed history, physical examination, and radiographic evaluation. This review article describes the reasons for failed ACL reconstructions as well as indications, preoperative evaluation, planning, and considerations of the procedure.