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Knee

ACL Revision

Primary ACL reconstruction is a highly successful operation with satisfactory outcomes as high as 97%. Still, some patients may experience unacceptable results. The incidence of revision ACL reconstruction is between 4.1% and 13.3% of all primary ACL reconstructions. Failure rates are higher in young, competitive athletes. It is important to identify the causes of failure to improve the success of revision surgery.

What is ACL revision surgery?

ACL revision surgery is a second surgery to repair the torn ACL ligament. The goal of revision surgery is to improve knee function, correct instability and facilitate a return to normal activities. Revision surgery can provide excellent results, treat graft rupture, structural failure, and functional failures.

What are the reasons for an ACL revision surgery?

There are multiple reasons for the need for revision surgery. The main reasons are reinjury, problems after the primary surgery and failure to heal. Early failure has been shown to be related to technical issues with the original surgery, graft failure and improper rehabilitation. Failures that occur six or more months after surgery are often related to premature return to sports or additional injury.

However, ACL tears are often accompanied by associated injuries such as meniscus tears, cartilage injuries and additional ligament injuries. Untreated injuries can affect ACL reconstruction and lead to failure. Revision surgery may be performed in conjunction with surgery to treat associated injuries.

What are the symptoms that indicate a potential need for revision surgery?

  • recurrent instability (knee giving out) due to structural or functional graft failure
  • pain
  • postoperative complications including infection, loss of motion, arthritis
  • preexisting comorbidities include malalignment and meniscus tears

How is the cause of failure diagnosed?

Dr. Petrigliano may order special tests such as an MRI or CT scan to determine the plan for revision surgery. Successful revision surgery requires an understanding of the cause of failure, careful surgical planning, meticulous surgical execution, proper postoperative rehabilitation, and appropriate patient counseling.

Dr. Frank Petrigliano is a knee expert who performs revision surgery for patients who seek an expert after a failed reconstruction surgery. He will perform a complete orthopaedic exam, review your medical and surgical history and order x-rays and an MRI. He will evaluate the factors surrounding your failed ACL reconstruction using a comprehensive approach to determine how best to address each factor that contributed to the failure. ACL revision surgery is technically demanding.

What are the options for ACL revision surgery?

Dr. Petrigliano must decide between a single stage and a two-stage revision.

  • Single stage revision surgery can be a reliable option with good clinical outcomes, low rerupture rates and high return to play rates, even in elite athletes.
  • Two stage revision surgery is rare and useful to address bone issues, active infections and malalignments, other ligaments injuries, and meniscus or cartilage defects.

ACL reconstruction surgery is common with more than 130,000 procedures each year. Excellent results can be achieved and even in the best of cases poor outcomes can occur. As with other surgeries, the more reconstructions a surgeon performs on a regular basis the higher the likelihood of a successful outcome.

Why choose Dr. Petrigliano?

Dr. Frank Petrigliano is an orthopaedic surgeon who was fellowship trained in sports medicine and shoulder surgery at the prestigious Hospital for Special Surgery where he provided care to athletes of all ages. He currently serves as the head team physician for the LA Kings hockey team and associate team physician for USC Athletics. Dr. Petrigliano is a renowned orthopaedic surgeon and researcher who employs state of the art treatments and procedures to get you back to your active life and back to sport. He always treats his patients with compassion and respect. Dr. Petrigliano is located in El Segundo California, and serves greater Los Angeles, Beverly Hills, the South Bay, and the Santa Clarita Valley. Contact Dr. Petrigliano to schedule a consultation today.

At a Glance

Dr. Frank Petrigliano

  • Associate Professor of Orthopaedic Surgery at USC
  • Chief of the Epstein Family Center for Sports Medicine
  • Team physician for the LA Kings and USC Athletics
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