Update in knee surgery – ACL revision

Clinical outcome after revision reconstruction of the anterior cruciate ligament (ACL) is influenced by many factors such as cartilage and meniscal status, coronary and sagittal axis deformities, concomitant ligamentous instabilities, patient activity and aspiration. Revision surgery often results in a worse clinical outcome compared to primary reconstruction. Detailed preoperative diagnosis with careful stability testing in the coronal, sagittal, and axial planes, as well as comprehensive imaging, is a prerequisite for comprehensive preoperative planning. The indication for revision surgery should be individualized. Concomitant pathologies must be considered in this planning and often require additional surgical care (e.g., correction of dorsal tilt of the tibial plateau, refixation of ramp and root lesions, additive extraarticular anterolateral stabilization, cartilage therapy). Essential treatment strategies are outlined.