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Despite the marked advances in treatment and highly predictable success of anterior cruciate ligament (ACL) reconstruction, an approximate 10% to 15% failure rate is noted in the literature. The mechanism of failure is often difficult to ascertain and is often multifactorial. A strong patient-physician relationship must be established to proceed with revision ACL reconstruction. After the decision has been made to proceed with revision ACL reconstruction extensive preoperative planning is warranted. Revision ACL recontructions are a “salvage” procedure to allow the patient to perform activities of daily living. A return to sports is a possibility, but the patient's expectations should be realistic and individualized. This article focuses on the surgical technique of revision anterior cruciate ligament reconstruction with patellar tendon allograft.