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It is estimated that more than 100,000 ACL reconstructions are performed each year.1 Recurrent instability has been cited as a frequent complication. Recently, there has been increased attention directed toward the anatomy and treatment of the posterolateral aspect of the knee. Because much research has been dedicated to ACL reconstruction, little has been written regarding the relationship between ACL reconstruction failure and the posterolateral aspect of the knee. This study serves to review the anatomy, biomechanics, diagnostic features, and surgical management of failed ACL reconstruction with concomitant posterolateral rotatory instability (PLRI).