When Do You Need ACL Revision Surgery?

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Why did your ACL reconstruction fail? Sometimes people re-injure their ACL. Other times the new ligament just didn’t heal properly. 

No one wants to undergo revision ACL surgery. However, sometimes there are no alternatives. Here’s how to know when you need revision ACL reconstruction and what to expect from the procedure.

Why Do You Need a Second ACL Surgery

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Over 100,000 ACL surgeries are performed in the United States every year. ACL graft failure only occurs in about 10% of patients, but - given that ACL surgery is one of the most common surgical procedures - this small percentage still comes out to a significant number of cases.

When a patient reports negative outcomes or dissatisfaction with their ACL surgery, this is considered a failure of the ACL reconstruction. This failure typically occurs for one of three reasons:

  1. The reconstructed ACL doesn’t heal properly

  2. Patients re-injure their ligament, either by returning to sports too soon or overdoing it in their rehabilitation  

  3. There are postoperative complications, such as infection

An ACL reconstruction failure is usually obvious. Symptoms often include:

  • Pain

  • Instability

  • Loss of range of motion

  • Stiffness

A physical examination by an experienced orthopaedic physician will help identify the potential cause of the ACL failure. After completing his evaluation, Dr. Sterett will determine if revision ACL reconstruction is needed and work with the patient to make surgical recommendations.

What to Expect From Your Revision ACL Surgery

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Revision ACL reconstruction is a more complex operation to perform than the initial ACL reconstruction surgery and requires much more preoperative planning. 

After identifying all the factors contributing to the primary ACL failure, Dr. Sterett and his team will recommend graft choices, which can include:

  • Autografts: Using the patient’s own ligaments (such as the hamstring, patellar, or quadriceps tendon).

  • Allografts: Using donated ligaments (such as Achilles, tibialis, or patellar tendon).

These grafts could either be the first stage of revision surgery or the second stage after attempting other options like a knee scope, realignment of the knee, or bone grafting of the ligament tunnels. The amount of surgeries needed for a revision ACL reconstruction depends on the extent of the first ACL reconstruction’s failure. 

Rehabilitation for a revision ACL surgery is fairly similar to the initial ACL recovery, but it will progress slower and be more individualized to the patient. Typically, Dr. Sterett and his team slow the rehabilitation exercises down to 50%, and patients are kept on crutches to minimize the stress on the ACL. The team rarely allows a full return to activities less than nine months post-operation. 

Questions About ACL Revision Surgery? Contact Team Sterett Today!

With over 30 years of orthopaedic experience, Dr. Sterett has the skill and know-how to provide his ACL revision patients with the best possible outcome. 


Contact Dr. Sterett today at (970) 426-7220 or via his online platform to discuss your questions and concerns about revision ACL reconstruction. He and his team will take the time to diagnose the reason behind the failure and identify how the revision must be performed, so you can get back to doing the activities you love.

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