Revision Anatomic Double-Bundle Anterior Cruciate Ligament Surgery

As the number of primary anterior cruciate ligament (ACL) reconstructions performed in the United States continues to increase, so will the need for revision surgery for “failed” primary surgery. These failed ACL surgeries are often the result of technical errors in the primary surgery. Current literature reports inferior functional and objective results of revision ACL surgery in comparison with primary surgery. This is often the result of unrecognized injury to the secondary stabilizers of the knee. The anatomic double-bundle ACL surgery has been shown to more accurately recreate the kinematics of the native knee in comparison with “classic” transtibial single-bundle ACL reconstructions. We believe that the use of the principals and techniques of anatomic double-bundle ACL reconstruction in the revision situation may be advantageous for many reasons. This is a technically demanding procedure that requires proper preoperative preparation. This article outlines our approach to these challenging situations.