Management of bone deficiency in revision anterior cruciate ligament reconstruction

A failed anterior cruciate ligament reconstruction (ACLR) not only can be a difficult situation for the patient, but also a challenging clinical scenario for the treating surgeon from a technical perspective. This review article discusses the etiology of primary graft failure; the importance of adequate history taking and need for an appropriate physical examination with diagnostic imaging; and the treatment decision making process for single vs. 2-stage revision ACLR with technical considerations reviewed as it pertains to bone deficiency and tunnel osteolysis.