Pre-operative planning in anterior cruciate ligament reconstruction revision surgery

Primary reconstructions of the anterior cruciate ligament are common and increasing in number, a trend inevitably paralleled by an increase in the number of revision procedures. Failure of primary ACL reconstruction can appear as objective residual laxity, subjective instability, severe and persistent postoperative stiffness and/or pain, or infection. Revision surgery is a complex procedure, in which the expected clinical outcome is inferior to that which can be expected from primary reconstruction, and patients have a 5.4% risk of undergoing a second revision after five years. This type of procedure demands correct and exhaustive preoperative planning so as ensure optimal treatment of accompanying lesions and of any complications arising during surgery. It is important to know, in detail, the patient’s clinical history (when the primary surgery was performed and the technique used, the cause of the recurrence, the degree of functional recovery, etc.), to perform a thorough clinical examination (to evaluate alignment, gait cycle, skin color, the trophic condition of the muscles, joint laxity), and to have available the results of a detailed and specific imaging study and also of blood tests, in order to exclude the presence of an infection