Surgical Information

Revision ACL Reconstruction

What is revision ACL reconstruction?

Revision ACL reconstruction is a second surgery to repair a torn anterior cruciate ligament (ACL) in the knee. Although primary ACL reconstruction has a high success rate, some patients are left with unsatisfactory results or they re-injure the ligament. Typical symptoms include recurrent knee instability, pain and inability to return to desired activities.

The type of surgery performed depends on many factors including the extent of damage, a patient's age, activity level, symptom severity and expectations. Two-stage procedures are sometimes necessary to remove any hardware used to fix the ACL in the first place and fill bone voids left by the first procedure. Most revision ACL reconstruction is done using knee arthroscopy, a minimally invasive technique in which the surgeon makes several small incisions around the knee joint, inserts an arthroscope, and uses tiny instruments to perform the procedure. Additionally, it is critical to evaluate for coincident injuries prior to proceeding with a revision surgery. Injuries to the menisci and cartilage, injuries to the collateral ligaments (MCL & FCL), and limb malalignment may also need to be addressed prior to, or at the time of revision surgery to optimize your outcome.

Revision ACL reconstruction surgery uses an autograft (tissue from your body) or an allograft (tissue from a cadaver) to replace the ligament. The autograft method is typically most successful in patients who want to return to a high-demand, athletic lifestyle. As patients get older, and demands diminish, the success of the allograft procedure increases. Ultimately, it depends on the unique needs of each individual. Different techniques work best in different situations. It is important that you consult a qualified orthopaedic surgeon to determine the best course of action for your individual circumstances.

Anatomy

The ACL is one of the major ligamentous stabilizers of the knee. It runs diagonally in the middle of the knee and connects the back of the femur to the front of the tibia. The ACL helps stabilizes the knee joint and keep it from rotating.

ACL tears are among the most common knee ligament injuries. They range from mild, small tears, to severe tears when the ligament and part of the bone separate from the rest of the bone. Most ACL injuries are complete or near-complete tears. A torn ACL can cause your knee to give way during physical activity.

When is surgery recommended?

If you have had primary ACL reconstruction and you re-injure your knee, experience recurrent knee instability or the ligament fails to heal even after extensive rehabilitation, revision ACL reconstruction may be a good option for you.

However, not everyone is a candidate for this procedure. It is important that you are evaluated by an experienced orthopaedic surgeon to determine the most appropriate treatment option.

What is the recovery time?

In general, rehabilitation following revision ACL reconstruction is takes a little longer than primary ACL reconstruction. Return to daily and sports activities varies depending on the type of surgery and your surgeon. Usually, return to sporting activity is restricted for at least nine months. An appropriate physical therapy program is considered critical for the success of revision ACL reconstruction.