Due to the steady increase in primary anterior cruciate ligament (ACL) reconstruction, and despite significant advancements in the treatment of ACL tears, there has been an associated rise in graft failure and revision procedures. Revision ACL reconstruction is a challenging procedure with worse outcomes than primary reconstruction. Surgeons approaching revision ACL must deal with several technical issues that require careful preoperative physical examination and instrumental analysis. Moreover, recognizing and addressing associated patient-specific risk factors and knee pathologies are mandatory to completely restoring knee joint stability and function. This chapter provides an overview of the principal risk factors and approaches to ACL revision surgery, followed by a summary of the leading technical issues, surgical treatments, and associated procedures that may be required in the setting of primary ACL reconstruction failure. Moreover, in the last section of the chapter, the authors present their preferred approach and technique for ACL revision surgery.