Principles of ACL Revision Surgery and Rehabilitation

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Revision anterior cruciate ligament (ACL) surgery is becoming increasingly common as the number of primary ACL reconstructions continues to rise. Revision ACL surgery is indicated for selected patients with recurrent instability after a failed primary procedure. Rehabilitation for primary ACL reconstructions has undergone an evolution, although very little has been published regarding rehabilitation following revision surgery. It is established that rehabilitation protocols following revision reconstruction should be more conservative than those used for patients with primary ACL reconstructions. The goal of revision surgery and rehabilitation is to recreate a functional knee that is stable for activities of daily living, and perhaps, stable enough to permit a return to sport. Rehabilitation following revision surgery must be individualized depending on a variety of factors including: staging, removal of hardware, graft selection, graft fixation, chondral defects, meniscal pathology, associated instability patterns, and alignment concerns. However, as with primary ACL rehabilitation, in general, the goal of early range of motion is crucial.

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