If your knee feels unstable again after ACL surgery, the graft tears, or the first procedure didn’t fix every issue in the joint, you may need a revision. At Steven Struhl MD – Shoulders & Knees, Dr. Steven Struhl, a board-certified orthopedic surgeon and shoulder and knee specialist, evaluates failed ACL reconstruction for patients in Midtown Manhattan and White Plains.
What Does a Failed ACL Reconstruction Feel Like?
Knee instability after ACL surgery can make your knee feel like it shifts, buckles, or gives way when you pivot, use stairs, or even just try to move through a normal day. You might also notice swelling after activity, pain, less confidence in your knee, or trouble getting back to sports.
The American Academy of Orthopaedic Surgeons explains that knee instability and related injuries help guide ACL treatment decisions. Your symptoms show something’s wrong, but they don’t reveal the cause by themselves. To get to the bottom of the issue, you’ll need a focused evaluation.
Why Can ACL Reconstruction Fail?
A new injury can re-tear an ACL graft, but that’s not the only reason a reconstruction can fail. Common problems include:
- A new twist, fall, or sports injury that damages the graft
- Graft tunnels that do not restore stable knee mechanics
- An untreated meniscus, cartilage, ligament, or alignment problem
- Graft stretching, fixation trouble, or incomplete healing
A 2025 review of planning for revision ACL reconstruction notes that the workup should account for the original injury, prior graft, associated damage, and tunnel placement before another operation.
What Happens During a Revision ACL Evaluation?
Dr. Struhl reviews the original injury and surgery, when instability returned, and which movements trigger it. He checks motion, strength, alignment, and ligament stability, then reviews prior operative records and imaging when available.
X-rays and MRI can show arthritis, cartilage or meniscus damage, the graft, and other knee structures. CT can help define the size and position of the old bone tunnels. This workup helps Dr. Struhl find out why your reconstruction failed and plan revision ACL reconstruction for your knee as it is now.
Can Revision ACL Reconstruction Take More Than One Surgery?
Most people can have revision surgery done in one stage. Sometimes, if the old tunnels are too wide or not in the right spot, you’ll need bone grafting first before the new ACL graft can be placed securely.
This difference is one reason revision ACL surgery needs careful planning. The evaluation also shows whether your meniscus, cartilage, alignment, or another ligament needs attention during the same procedure.
FAQs
Can physical therapy fix a failed ACL reconstruction?
Physical therapy can help you build strength and control, but it can’t repair a torn or poorly positioned graft. Dr. Struhl will help you decide if rehab is still right for your knee or if ongoing instability means it’s time to consider surgery.
Do you need an MRI before revision ACL surgery?
Imaging is important for most revision evaluations. MRI checks the graft and soft tissues, while X-rays or CT give a clearer look at alignment, hardware, and bone tunnels.
Schedule a Revision ACL Evaluation in NYC or Westchester
If your knee keeps shifting, giving way, or holding you back after ACL surgery, schedule an evaluation with Steven Struhl MD – Shoulders & Knees. Dr. Struhl offers revision ACL reconstruction in NYC and White Plains, with a plan built around why your first reconstruction failed and what you need your knee to do.
