Optimizing Outcomes in Revision Anterior Cruciate Ligament Reconstruction.

Revision anterior cruciate ligament reconstruction, although increasing in incidence, is associated with inferior outcomes compared with primary anterior cruciate ligament reconstruction. Anterior cruciate ligament graft failure is often multifactorial, even in the setting of traumatic anterior cruciate ligament graft tear. Surgeons should assess for technical, biologic, and patient-related risk factors for anterior cruciate ligament graft failure through a comprehensive history, physical examination, and imaging evaluation. It is important to review the causes of anterior cruciate ligament graft failure and provide a framework for preoperative workup and planning to optimize outcomes in revision anterior cruciate ligament reconstruction. Surgical considerations include staging of surgery and graft choice. Indications for concomitant procedures include lateral extra-articular procedures, slope-correcting osteotomy, and meniscus repair or transplantation.