A failed ACL reconstruction has a cause, and a revision that does not address it tends to fail the same way. The work-up is mostly imaging you already have.
Tunnel position, slope and associated laxity account for much of what goes wrong, and each needs a specific answer at revision.
- Check tunnel position and widening on radiographs and CT; widened tunnels may need staged grafting.
- Measure posterior tibial slope on a true lateral view of the knee.
- Examine for posterolateral, anterolateral and medial laxity that a single graft will not control.
- Look on MRI for an untreated meniscal root or ramp lesion.
- Ask about the return-to-sport timeline and rehabilitation after the first surgery.
Why it matters
Revision outcomes are worse than primary ones, so finding the cause is the main lever you have.
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