ACL injuries have been steadily increasing in incidence for years. Children and adults alike often elect to undergo an ACL reconstruction in the hopes of returning to sports with a stable knee.
Unfortunately, at least 20-25% of people who injure their ACL will go on to tear their new ACL or their other ACL. That means that thousands of people each year are undergoing a second ACL surgery — or a revision ACL reconstruction.
A revision ACL reconstruction is a lot more complicated than your initial ACL surgery. During a revision surgery we need to determine if your first ACL was performed properly and we can use the old tunnels … or we need to determine if we need to close up your old tunnels with a bone graft and come back in a few months to put the revision ACL in place.
Obviously waiting for the bone graft to heal and close the tunnels is very unfortunate, but it is done to give you the best chance of a good recovery from a revision ACL surgery.
From your perspective, the recovery from revision ACL surgery will be very similar to the recovery from your first ACL surgery. Your rehabilitation is just as critical as the surgery if you hope to return to sports.
For many years we suspected that the chance that you would be able to return to sports after a second acl reconstruction was lower… but we didn’t have many significant quality research studies to support that theory.
The paper quoted below helps shed some light on this topic. The authors found that your chance of returning to sports after a revision ACL reconstruction is in fact lower than your chance of returning from your first ACL surgery; but the authors found that the rate of return is not as low as we feared in might be.
Return-to-sport rates of patients after revision ACLR were similar to those after their primary surgery but were still lower than the reported rates of ACLR patients who did not need revision surgery.
Source: Return-to-Sport Outcomes After Revision Anterior Cruciate Ligament Reconstruction Surgery
Hopefully you never find yourself needing to think about a revision ACL reconstruction. But if you do, and if your second surgery is successful, then it appears that you have a reasonably good chance of returning to sports.
Scott S says
Dear Dr. Luks, our now 14 year old son had a complete ACL tear March 2015. He had surgery April 2015 using his hamstring. The surgeon needed to avoid his growth plates. All went great. He rehabbed and was practicing baseball and heard a dreaded pop Feb 2016. We had an MRI done 2/22/16 which showed at least a partial tear but it was possible that the graft was partially in tact. We met with the surgeon and he told us that based upon the exam his knee would need a second surgery and recommended an allograft. My son is stilll growing and did PT for 6 weeks before second surgery. We had a final exam this week before the second surgery. The surgeon said the knee is now much more stable, he did the lochman test and said his knee now has an endpoint that was not there in February. It is still not perfect, but he thinks it maybe healing. We will get another MRI, but the surgeon has canceled the second surgery. He said if my son needs a second surgery, we should wait until he is skeletal mature and then due a BPB graft. My son says his knee feels great, no instability, runs, jumps and cuts without any instability to this point.(Nethier pops resulted in any meniscus or other damage) Surgeon says he can play baseball now, but needs to use his Donjoy brace and may want to do a platelet infusion to further healing.
Dr Luks, Do you think a partially torn hamstring graft can repair itself? Do you think a revision surgery should wait until maturity and closed growth plates? What are your thoughts on Platelet infusion? Any other advice on this situation?
Oscar Pineda says
Hi Dr. Luke, thank you for sharing all your wisdom about the different types of surgeries. I did a lot of research before having patellar tendon ACL reconstructive surgery and your site has truly been the most informative and helpful.
To give you a quick background about myself, I tore my ACL, medial and lateral meniscus on my left leg from a downhill mountain biking accident. My lateral meniscus was deburred where the complex tear was located and my medial was left alone because the peripheral tear was in the red zone. Trust me, I’m no Doctor or med student but I did my homework to become a well informed patient. Being a 30 year old active male, I do not regret my decision having this surgery. Prior to having surgery, I didn’t have knee control or balance without having my McDavid level 3 brace. Therefore, returning to my active lifestyle was a must and surgery was inevitable.
After reading through your blogs, I haven’t been able to read anything on recovering patients. I’m currently in my 10th week post surgery, keeping up with therapy and rehabbing daily at the gym. I’m concerned with having full extension because I have to stretch every morning and night to accomplish this. I’m off by 2-4 degrees daily when I wake up or as the day progresses and I’m off my leg. Would you consider this normal from your professional opinion? What exercises should I perform to strengthen my leg to have full extension?
Thanks for all the help,
Howard J. Luks, MD says
Physical therapy is really one of the most critical aspects of recovering from an ACL reconstruction. Without proper PT you are at risk of having a poor result or potentially having another tear. Getting back full extension is critical so keep pushing it. Having a little difficulty in getting full extension is pretty normal for most people… but they do get it back with effort.
Siddharth Mukherjee says
Hi Dr. Luke,
3 years back, I had a very unfortunate event in which I tore my ACL and medial meniscus (bucket handle tear). On March 26th 2015, I had an ACL Reconstruction+OATS. Recovery was going really good till the 4th Month. In my 5th month post operation, while I was jogging, I twisted my knee and ended up with a lot of pain and swelling. My surgeon told me that my ACL Graft tore partially and that I needed another surgery because my knee was very lax. Anyway, after 2 years from that incident, I underwent ACL Revision Reconstruction on 19th June 2017 from a different surgeon. Right now, it’s my 6 weeks post operation and I feel some discomfort in my knee. My tibia shifts forward, there were frequent episodes in which I had little twists in my knee. I have full flexion too. I talked about this to the surgeon and he said that it’s happening because it’s my second surgery. (He confirmed that after doing Lachman Test and Anterior Drawer Test). My question is, is there really some laxity after Revision ACL Surgery?
Howard J. Luks, MD says
There shouldn’t be… but revision ACL surgery does not have the same success rate as the primary or first ACL surgery.
I have an 18 yo son who is about to go play D1 lacrosse. He tore his right ACL 20 months ago and just tore his left ACL. What are his chances of ACL injury ? Do we insist he quits playing?
Howard J. Luks, MD says
An athlete who tears their ACL has a 20-30% chance of injuring the ACL in the other leg or the rehabilitated leg. Some parents do make the tough decision to stop participation in sports. Many more will delay that decision until after the same knee has been injured twice. This is not an easy decision to make. If you and your son elect to continue to participate in sports you must have him and hopefully, his whole team— adopt the FIFA11 ACL prevention program. It’s a simple 20 min pre-practice, pre-game process that is proven to dramatically decrease the risk of ACL injuries.