Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction.

PURPOSE: The purpose of this article was to discuss pre- and intra-operative considerations as well as surgical strategies for different femoral and tibial tunnel scenarios in revision surgery following primary double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: Based on the current literature of ACL revision surgery and surgical experience, an algorithm for revision surgery after primary double-bundle ACL reconstruction was created. RESULTS: A guideline and flowchart were created using a case-based approached for revision surgery after primary double-bundle ACL reconstruction. CONCLUSION: Revision surgery after primary double-bundle ACL reconstruction can be a challenging procedure that requires flexibility and a repertoire of surgical techniques. The combination of pre-operative planning with 3D-CT reconstruction, in addition to careful intra-operative assessment, and the use of this flowchart can simplify the ACL revision procedure. LEVEL OF EVIDENCE: V.