Two-stage ACL revision: Indications and technique

Despite the reported success of primary ACL reconstruction graft failures can occur. Recurrent instability after ACL reconstruction is a multifactorial problem that can be simplified by considering the failure in two simple categories: traumatic and atraumatic failures. Modes of atraumatic failure include failure of graft ligamentization or biologic failure of the tissue, associated posterior medial or lateral laxity, meniscal deficiency, bone tunnel widening or lysis and technical error. A successful revision reconstruction procedure is directly related to the surgeon's ability to adequately place a graft and provide enough fixation until graft incorporation within the tunnels occurs. This chapter will focus on the indications and techniques for a two-staged technique for revision ACL reconstruction surgery utilizing a case-based approach.