Anterior cruciate ligament (ACL) revision

A surgical procedure to correct a failed ACL repair operation.

About ACL revision surgery

Anterior cruciate ligament (ACL) revision surgery is a procedure to correct a failed ACL reconstruction. The ACL is a thick band of tissue that joins the thigh bone to the shin bone in your knee. It can be torn as a result of a sudden twisting or wrenching movement. If you've had ACL reconstruction surgery in the past, it's possible that the graft (a tendon taken from another part of your body) might have failed. This could be because:

  • the graft was attached at the wrong point in the bone
  • other knee instabilities were not addressed during the original procedure
  • your body did not accept the graft properly
  • you returned to activity before your body had accepted the graft properly
If the original surgery failed, your symptoms might include pain, swelling and knee instability. Surgery should help ease your symptoms if you're a very active person and physiotherapy has failed to help.

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How is ACL revision carried out?

ACL revision is carried out through keyhole surgery (arthroscopically), usually under general anaesthetic. You'll be asleep during the operation. Your surgeon makes a number of small cuts and inserts a telescopic video camera and surgical instruments. Depending on the cause of graft failure, your surgeon might need to graft more bone into the original area where the tendon was attached.

  • If the graft tendon has torn – your surgeon will take more tendon from your thigh or knee or may use a donor ligament, and insert the ends into your thigh bone and shin bone.
  • If the cartilage has torn – your surgeon will correct these issues by shaving or repairing the cartilage .
The cuts are then stitched and a dressing is applied to your knee. A brace is normally fitted from anything from two to six weeks depending on your injuries and the amount of surgery you've required.

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Recovering from ACL revision

You will usually go home on the same day as the surgery, or when you have recovered from the anaesthetic.

Recovery from revision reconstruction is usually takes longer than for the original ACL reconstruction.

Initially, you will need to rest your leg and keep it elevated as much as you can.

You'll need to use crutches for up to four to six weeks and wear a knee brace for a similar amount of time.

You can expect to return to work about six weeks after the operation if your job isn't too physically demanding. Those with more active jobs will need a longer recovery time.

You should be able to start doing single leg squats and gentle jogging after four months. It usually takes nine months to make a full recovery and return to sports.

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Published: 10 December 2019 | Review: 10 December 2022

Disclaimer: This information is published by Cromwell Hospital and is based on reputable sources of medical evidence and experience from over 30 years of treating patients. It has been peer reviewed by Cromwell Hospital doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. If you have any feedback on the content of this patient information document please email info@cromwellhospital.com or telephone 020 7460 5901.