Anterior cruciate ligament (ACL) revision

A surgical procedure to re-do a failed ACL repair operation.

What is 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 might not have been suitable 
  • Other knee instabilities were present 
  • Your body did not accept the graft properly
  • You may have returned to activity before your body had accepted the graft properly. 

If the original graft 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. 

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. 

ACL revision surgery can be carried out in either one or two operations depending on the nature of clinical findings. This would involve doing specific imaging, such as X-ray, CT, and MRI scans. 

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 may be required from two to six weeks depending on your injuries and the amount of surgery you’ve required. 

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

Recovery from revision surgery 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 between two to 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 six months. It usually takes nine months to make a full recovery and return to sports. You will need to pass a fitness return to sports test carried out by your physiotherapist prior to returning to sports.

Long-term, if you do sports such as skiing or contact sports, you may need to wear an ACL-specific brace to protect the re-do surgery.

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