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Revision anterior cruciate ligament surgery: state of the art

Abstract

With the increase in number of anterior cruciate ligament (ACL) reconstructions being performed, and with patients' desire to return to high-level sports activities, the prevalence of ACL revision has been rising despite recent improvements in ACL reconstruction technique. ACL reconstruction failures can be classified into 3 general categories: recurrent instability, postoperative complications and patient comorbidities. Of these 3 categories, recurrent instability is the most common cause for revision surgery. Cases of recurrent instability can be further subdivided into 2 groups: traumatic and atraumatic. Causes of atraumatic failure include technical errors, missed associated injuries, biological factors and infection. Careful preoperative evaluation and planning, sophisticated surgical technique (including individualised graft selection, anatomical tunnel placement and secure fixation), careful evaluation and treatment of all associated injuries, and individualised rehabilitation are all essential for successful revision ACL surgery. There have been very few high-level studies in the field of revision ACL surgery; therefore, accumulating more evidence for clinical outcomes and prognostic factors to improve revision surgery procedure will be necessary. Both primary ACL injury prevention and reinjury prevention, as well as individualised anatomic primary ACL reconstruction, are critical to reduce the incidence of revision ACL surgery.

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