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Revision ACL Reconstruction with Contralateral patellar Tendon Autograft


Serving as a stabilizer for the knee joint, the anterior cruciate ligament (ACL) is one of the four main “restraint” ligaments. The ACL is located in the front of the knee and provides stability during rotational and twisting movements, as well as preventing the bone in the leg (tibia) from moving forward relative to the bone of the thigh (femur). ACL tears and other injuries to the ligament are quite common in all athletic levels. Many patients will hear a pop at the time of injury and then experience knee pain and swelling. The ACL does not heal on its own due to the nature of the ligament and the knee’s anatomy. In active individuals, an ACL reconstruction is typically recommended to reconstruct the ligament, leading to restored knee stability and function. An ACL reconstruction is very effective, but some patients may experience a re-tear of the reconstructed ligament as a result of a recurrent injury or gradual stretching of the graft over time, causing a failed ACL reconstruction. In these cases, a revision ACL reconstruction is typically recommended and performed by Dr. Brian Waterman.

The primary cause of a failed ACL reconstruction is a poorly positioned ACL graft from the original surgery. Patients may also experience a re-tear from new knee trauma, returning to athletic activities too soon, failure to wear the brace or follow rehabilitation guidelines following surgery. Patients who have malalignment of the lower extremity, such as patients who are bow legged, may experience a failed ACL reconstruction caused by poor alignment of the entire leg.

When a re-tear occurs, the knee joint must be carefully examined before a revision ACL reconstruction can be performed. Dr. Waterman must first determine the cause of failure so he can properly plan the revision procedure and eliminate the risk of a second failure. He will perform new X-rays, CT scan and an MRI scan to examine why the surgery failed and to see if the patient is predisposed to additional ACL tears.

A revision ACL reconstruction may be performed immediately after a re-tear using a graft from the patient or from a donor. The type of graft selected by Dr.Waterman will be determined on the circumstances connected to the first procedure, such as graft placement and how it was used. A staged surgery may be necessary following a failed ACL reconstruction. Patients who have low bone quality typically benefit most from a staged procedure. This consists of a bone grafting procedure designed to fill in the damaged areas with new bone, and then approximately four to six months later a revision ACL reconstruction with a new graft will be performed.


Patients will be placed in a brace and instructed to start a rehabilitation program designed by Dr.Waterman immediately following the procedure. Crutches are commonly used for up to two to four weeks and a functional brace may be used for the first year during athletic activities. The majority of patients can expect a full recovery in nine to twelve months.

It is important to note that a primary ACL reconstruction is very successful at restoring function and stability to the knee joint. A revision ACL reconstruction is also highly successful but less so than the original surgery due to the complexity of the injury and revision procedure. Because of this, it is critical to select an orthopedic knee surgeon highly skilled and experienced at revision ACL reconstructions.

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At a Glance

Dr. Brian Waterman, MD

  • Chief & Fellowship Director, Sports Medicine, Wake Forest
  • Team Physician, Wake Forest University, Chicago White Sox
  • Military affiliation/Decorated military officer and surgeon
  • Learn more

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