Revision anterior cruciate ligament surgery.

j t nterior cruciate ligament (ACL) reconstruction surgery is one of the most frequently performed perative procedures in orthopaedic surgery. There re estimates that 100,000 new ACL injuries occur nnually. Marked improvements have occurred in the ast 15 years with regard to graft selection, tunnel lacement, graft fixation, and rehabilitation that have esulted in predictable outcomes for ACL surgery sing patellar tendon, hamstring, quadriceps tendon, utograft, and allograft tissues. Nevertheless, most tudies report a clinical failure rate of between 10% nd 15% at shortand intermediate-term followps.1-3 Increasing numbers of ACL reconstruction ailures are being seen.4-11 The purpose of this article s to discuss the etiology of failure, approaches to the ailed ACL patient, surgical technique issues, and esults of revision ACL surgery.7 The author has been in practice since 1986 and has erformed nearly 1,200 ACL reconstructive surgeries. atellar tendon autograft has been the predominant raft source in over 90% of the primary ACL surgeres, and between 75 and 100 ACL reconstructions are erformed annually. Of note is that my personal reviion rate has been less than 1%, although our clinical ollow-up studies would suggest a 10% failure rate. urrently, between 5 and 10 ACL failures are revised nnually; the majority of these patients are referred to ur center. Nonirradiated patellar tendon allografts are he primary graft choice in the majority of these paients. My revision experience is reflective of the maturaion of my practice. In the first 5 years of, between 986 and 1991, I had minimal experience (n 2) with