Approach to the multiply revised ACL-deficient knee

Abstract

Patients with an ACL injury commonly present to the sports orthopaedic surgeon. In the United States alone, approximately 200,000 ACL ruptures and up to 175,000 reconstructions occur per year. ACL graft failure presents a challenging scenario that is increasingly encountered in clinical practice. In an attempt to understand the risk factors for primary reconstruction failure and improve the outcomes of revision surgery, the Multicenter ACL Revision Study (MARS) was established in 2006. Over a 3-year period, 460 patients with ACL reconstruction failure were prospectively enrolled and subsequently underwent revision reconstruction. In their epidemiological report, over 11 % of the cohort had experienced multiple reconstruction failures. Clinical decision-making and technical considerations for repeat revision ACL reconstruction are the focus of this chapter.