Revision ACL Reconstruction: Tunnel Placement Issues

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The revision rate of anterior cruciate ligament (ACL) reconstruction is between 3% and 25%, with the suboptimal surgical technique contributing to 77% to 95% of failures of the index procedure. The cause of failure of ACL reconstruction should be clearly identified before proceeding with revision ACL reconstruction. Incorrect tunnel placement is the most commonly identified surgical error. In this paper, we describe the radiographic evaluation of proper tunnel placement, discuss the indications for 1-stage and 2-stage ACL revision reconstruction, and describe techniques for 1-stage and 2-stage ACL revision reconstruction. The overall reported results after revision ACL revision reconstruction are inferior to primary ACL reconstruction. Patients should be appropriately counseled with respect to expected postoperative outcomes.

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