ACL Revision Surgery
Re-injury Following ACL Surgery
ACL Revision may be indicated in the setting a failed ACL reconstruction. Re-tears may occur for a variety of reason including trauma, failure of graft healing, return to sport too early, poor surgical technique, untreated associated injuries or improper rehab. Given the complexity of the problem, it is essential important to follow a measured approach to evaluate, diagnose, and treat ACL re-injury cases.
A proper work-up includes a thorough physical examination and imaging. Imaging may include long leg alignment X-rays, repeat traditional X-rays, MRI and possibly a CT scan. These images will help elucidate the reasoning for graft failure, and also assist in planning for a potential ACL revision surgery.
Treatment for a failed ACL graft may require a staged approach, meaning more than one surgery. In certain instances, an initial surgery is necessary to remove previous hardware, bone graft prior tunnel sites and/or address other injuries. A second surgery would be scheduled at a later date to complete the revision ACL reconstruction. Of note, note all ACL revision cases required a 2-stage approach.
Graft choices is based on multiple considerations previous grafts used and age. At times, the contralateral (opposite) extremity may be the site of ACL graft harvest (donation site).
The rehabilitation for a revision ACL reconstruction is similar in sequence, but slower in speed, and the ultimate return to sport generally occurs after a longer duration of rehab. Each rehabilitation program will be individualized to match the patient’s needs.
Revision ACL reconstruction is a complex procedure and necessitates a through work-up, detailed surgical plan, and a comprehensive rehab strategy. The most successful outcomes involve a team-based approach between the patient, our physicians and athletic trainers, and our trusted physical therapy providers in the community.