Revision anterior cruciate ligament (ACL) reconstruction is performed after a previous ACL reconstruction has failed. The goals of revision surgery are to address the reason for failure, correct technical errors, properly reconstruct the torn ligament, repair other damaged structures, and restore function and stability to the knee.
Dr. Chudik specializes in treating failed ACL reconstructions. Revision surgery may involve removing the failed graft, correcting or bone grafting previous tunnels, placing a new graft anatomically, and treating associated injuries to the ligaments, meniscus, cartilage, or bone.
What Is Arthroscopic Anatomic ACL Reconstruction?
Revision ACL reconstruction replaces a failed ACL graft with a new graft. Because revision surgery is more complex than primary ACL reconstruction, the reason the previous reconstruction failed must also be addressed.
Dr. Chudik performs revision ACL surgery with the assistance of an arthroscope, a small camera inserted through small incisions that allows him to view the inside of the knee.
During surgery, the failed ACL graft is removed. Previous bone tunnels may be bone grafted and revised in the tibia (shin bone) and femur (thigh bone), and the new graft is placed anatomically where the normal ACL was located.
Dr. Chudik prefers to use the patient’s own tissue when possible. However, allograft tissue may sometimes be necessary because previous graft tissue has already been used or because an allograft can provide the necessary graft size.
Who Is a Candidate?
Revision ACL reconstruction may be recommended for:
- Patients who have failed a previous ACL reconstruction and regularly participate in sports requiring pivoting, cutting, jumping, and landing
- Patients with recurrent giving way or knee instability despite an adequate rehabilitation program after a failed ACL reconstruction
- Patients with associated injuries such as a repairable meniscus tear, articular cartilage injury, or another ligament injury that may also require surgical treatment
For individuals who do not participate in activities requiring frequent pivoting, cutting, jumping, and landing, surgery may not always be the best option.
Patients who are unable or unwilling to complete the necessary postoperative rehabilitation program should not have surgery. A current or previous knee infection is a concern, although it is not an absolute contraindication. Severe knee arthritis and damaged cartilage may also be contraindications.
How the Procedure Is Performed
Revision ACL reconstruction is performed with the assistance of an arthroscope and is usually an outpatient procedure, allowing the patient to go home the same day.
The surgery is performed with general anesthesia and a nerve block. The failed ACL is replaced with a new graft. Before surgery, Dr. Chudik discusses the available graft options and determines the appropriate graft for the patient.
During surgery:
- The failed ACL graft is removed
- The other ligaments, meniscus, cartilage, and bone are evaluated and treated appropriately
- Previous bone tunnels may be bone grafted and revised in the tibia and femur
- The new graft is positioned anatomically where the normal ACL was located
- Special fixation devices hold the graft in position while it heals and usually do not need to be removed
Many ACL revisions require staged procedures to accomplish all of the surgical goals. Dr. Chudik has developed instruments and techniques that allow some revision ACL surgeries that typically require multiple operations to be performed in a single procedure.
Recovery and Rehabilitation
Following revision ACL reconstruction:
- Crutches and partial weight bearing are used for approximately four weeks for an isolated ACL reconstruction
- A postoperative knee brace is used for 24 hours if a regional femoral block was used, or for six weeks if the meniscus or another ligament was also repaired or reconstructed
- The wound should be kept clean and dry for the first 10 to 14 days
- Light showering is allowed after two weeks, but the wounds should not be submerged in water for three weeks
- Driving may resume after six weeks when the right leg is involved
- Return to school or sedentary work may occur in less than one week as long as the leg can be elevated
- Physical therapy to restore motion, strength, and proprioception (balance) may continue for four to six months
Walking and regular daily activities may resume once the patient is off crutches, generally about four to six weeks after surgery. Return to running may occur at about three months, with return to sports at approximately four to six months.
After the knee is fully rehabilitated, Dr. Chudik performs an ACL Functional Capacity Evaluation to determine whether rehabilitation is complete and whether movement patterns known to increase the risk of injury to the reconstructed ACL or the other knee have been corrected before return to activities.
Risks and Outcomes
Potential risks and complications include:
- Infection
- Nerve injury resulting in numbness around the knee; a small area of temporary or permanent numbness around the incisions is not uncommon
- Postoperative infection that may require staged surgery and removal of the ACL graft
- Re-rupture or stretching of the reconstructed ligament, resulting in recurrent instability, which is more common with allografts
- Knee stiffness requiring prolonged rehabilitation or repeat surgery
- Patellar tendon rupture, patellar fracture, patellofemoral arthritis, or kneeling pain if a bone-patellar tendon-bone graft was previously taken
- Rare pain from the fixation device used to hold the graft
- Rarely, a blood clot in the veins of the calf or thigh that may travel to the lungs
Revision ACL surgery is more complex because the reason for the previous failure must be addressed along with reconstruction of the ligament and treatment of associated injuries.
For some revision cases that would otherwise require multiple staged procedures, Dr. Chudik’s specialized techniques may allow the necessary work to be completed in a single procedure, shortening recovery to that of a primary ACL reconstruction—less than six months rather than more than one year for multiple staged procedures.
Why Dr. Chudik for Arthroscopic ACL Reconstruction
Dr. Chudik specializes in treating failed ACL reconstructions and evaluates the reason the previous surgery failed, including technical errors in graft positioning and problems with existing bone tunnels.
During revision surgery, he can remove the failed graft, correct and bone graft previous tunnels when necessary, anatomically reconstruct the ACL, and address associated injuries to the ligaments, meniscus, cartilage, and bone.
Dr. Chudik has also developed instruments and techniques that allow some complex revision ACL reconstructions that would typically require multiple staged operations to be completed in a single procedure.