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Revision ACL Surgery: A Comprehensive Approach


Revision ACL surgery is a critical procedure undertaken when a previous anterior cruciate ligament (ACL) reconstruction has failed or complications have arisen. 

In this blog post, we’ll delve into the intricacies of revision ACL surgery and explore the comprehensive approach necessary for its success.

What is revision ACL surgery?

Revision anterior cruciate ligament surgery is a procedure performed to address a failed or compromised initial ACL reconstruction. When an ACL tear occurs, surgical reconstruction may be necessary to restore stability and function to the knee joint. 

However, in some cases, the initial ACL reconstruction may fail to achieve the desired outcome, leading to persistent symptoms such as instability, pain, and reduced function.

Revision ACL surgery involves a meticulous surgical approach to address the factors contributing to the failure of the initial reconstruction. Surgeons must assess the integrity of existing grafts, identify any residual instability, and address any anatomical abnormalities that may have contributed to the failure of the initial surgery.

While primary ACL tears are common, accounting for approximately 200,000 cases per year in the United States alone, revision surgeries pose unique challenges. 

Patients undergoing revision ACL surgery often face a greater risk of complications and more extended recovery periods compared to primary procedures.

When is it needed?

Revision ACL surgery is needed when a previous ACL reconstruction has failed or has not provided the desired outcomes. Several scenarios may necessitate revision ACL surgery:

  • Persistent instability: If a patient continues to experience knee instability, giving way, or a feeling of looseness in the knee joint following the initial ACL reconstruction.
  • Graft failure: In some cases, the graft used in the initial ACL reconstruction may fail to integrate properly with the surrounding tissue or tear again. Revision surgery may be required to replace the failed graft and restore stability to the knee joint.
  • Recurrent injury: Patients who have undergone ACL reconstruction may experience a recurrent ACL tear due to traumatic injury or participation in high-risk activities.
  • Persistent symptoms: Despite undergoing ACL reconstruction, some patients may continue to experience symptoms such as pain, swelling, or limited range of motion in the knee joint.
  • Complications: Following ACL reconstruction, complications such as infection, stiffness, or improper healing may occur, necessitating revision surgery to address these issues and optimize outcomes.
  • Anatomical abnormalities: In some cases, anatomical abnormalities such as malalignment or insufficient bone stock may contribute to the failure of the initial ACL reconstruction

How to prepare for revision ACL surgery?

Thorough pre-operative evaluation is essential before embarking on revision ACL surgery. This evaluation includes a comprehensive physical examination, imaging studies such as MRI scans, and an assessment of the patient’s previous surgical history. 

Furthermore, understanding the factors contributing to the failure of the initial surgery is crucial for determining the best course of action.

What happens during revision ACL surgery?

During a revision ACL surgery, the orthopedic surgeon performs several steps to address the failed or compromised initial ACL reconstruction. This includes the following:

Anesthesia and incision

Before the surgery begins, you’ll be administered anesthesia to ensure you’re comfortable and pain-free throughout the procedure. 

Then, the surgeon makes an incision over the knee joint to access the previous surgical site. The size and location of the incision may vary depending on factors such as the presence of scar tissue and the surgical approach chosen by the surgeon.

Evaluation of previous graft

The surgeon carefully evaluates the integrity of the previous graft in the initial ACL reconstruction. This may involve removing any scar tissue or adhesions that have formed around the graft to assess its condition.

Graft harvesting or selection

Depending on the surgeon’s preference and the patient’s unique circumstances, a new graft may be harvested from the patient’s own tissue (autograft) or obtained from a donor (allograft). 

Common graft options include the patellar tendon, hamstring tendon, quadriceps tendon, or donor tissue.

Graft preparation and implantation

Your surgeon will prepare the harvested graft by trimming and sterilizing it before implantation. The surgeon removes any remnants of the previous graft and prepares the bone tunnels in the tibia and femur to accommodate the new graft. 

The graft is then securely anchored in place using specialized fixation devices such as screws, staples, or interference screws.

Ligament reconstruction

With the new graft in place, the surgeon reconstructs the ACL by securing the graft to the appropriate anatomical landmarks in the knee joint. This restores stability and function to the knee and helps prevent recurrent instability and further injury.

Once the ACL reconstruction is complete, the surgeon carefully closes the incisions using sutures or surgical staples.

What to expect during rehabilitation and post-operative care?

After the surgery is complete, you’ll be taken to a recovery area, where you’ll be monitored closely as you wake up from anesthesia. Depending on the surgeon’s instructions and the specific surgical protocol, you may be discharged home the same day or kept overnight for observation.

Rehabilitation following revision ACL surgery plays a vital role in facilitating recovery and restoring function. A comprehensive rehabilitation program focuses on the following:

  • Promote early mobilization to prevent stiffness.
  • Restoring the range of motion.
  • Strengthening the muscles surrounding the knee.
  • Improving walking patterns.
  • Gradually reintroducing weight-bearing activities.
  • Gradually perform functional activities.

Physical therapists work closely with patients to tailor rehabilitation protocols to their needs and goals. While the timeline for returning to sports and activities may be longer than that for primary ACL surgery, adherence to the rehabilitation program is essential for minimizing the risk of re-injury.

Gradual return to functional activities may start during the 6th-12th week of rehabilitation. However, full recovery from a revision ACL surgery can take up to a year or longer, depending on individual factors and the complexity of the surgery.

Where to find the best outpatient orthopedic clinic?

At Raleigh Orthopaedic Surgery Center, we specialize in various orthopedic procedures, including revision ACL surgery, joint replacements, sports medicine interventions, spine surgery, and more. 

As a leading outpatient orthopedic clinic, we offer these procedures in a comfortable and efficient setting.

Our team of board-certified Raleigh orthopedic surgeons is committed to delivering the highest quality of care with precision, expertise, and compassion. They are among the best in the field, utilizing state-of-the-art techniques and advanced technology to achieve optimal outcomes for our patients. 

Whether you’re an athlete striving to get back in the game or an individual seeking to regain mobility and function, you can trust us to provide personalized care and support every step of the way.

Contact us to learn more.

The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.