ACL Revision

Advances in surgical technique and refined understanding of the ACL, as well as the implementation of structured rehabilitation following ACL reconstruction have led to an overall percentual decrease of ACL revision rates over the past decades. However, as the incidence of ACL rupture and consecutive reconstruction is steadily increasing, the absolute number of ACL revision procedures is on the rise. The reason for ACL failure is multifactorial as several factors modulate the susceptibility to ACL graft failure including surgical technique, anatomy, neuromuscular status, biological healing processes, concomitant pathology and trauma exposure. Well-defined endpoints of ACL reconstruction failure such as pathologic instrumented laxity and radiologically verified ACL graft discontinuity are more likely to result in revision surgery compared to less-well defined endpoints such as unsatisfactory PROM scores. The approach to ACL revision is typically based on individual assessment of the patient including multiple parameters in agreement with patient expectations. Revision ACL reconstruction is performed as a one-stage or two-stage procedure dependent on several factors including primary ACL tunnel position and status. Currently, an increasing role of LEAP in ACL revision is observed while clear indications and benefits are still controversially discussed.