Second Time Is Not The Charm: HSS Doctor Talks Re-Injuring ACL

STAMFORD, Conn. -- One of the most common knee injuries is a torn ligament, and the anterior cruciate ligament is the one we often read about in the sports pages. Although primary ACL reconstructions have a high success rate, some patients are left with unsatisfactory results or they re-injure the ligament. About 10 percent of the ACL reconstructions performed in the United States fail within 10 years.

by Dr. Robert Marx

Content Partner: Hospital for Special Surgery

The main reasons a patient might need a revision ACL reconstruction include re-injury, problems arising from the previous surgery, or failure of the reconstructed ligament to heal properly.

Revision surgeries are a more challenging operation for the orthopedic surgeon. Primary ACL reconstructions are performed using different techniques, so the surgeon must take multiple factors into account when planning for the more complex procedure.

The decision to proceed with a second ACL surgery depends on the patient, the condition and stability of his or her knee, the desired activity level and imaging findings. Patients are advised to seek out a specialist with ample experience in revision ACL surgery for the best chance of a good outcome. With careful planning, many patients can have excellent results and return to a very high level of activity without knee instability.

People who do not experience instability in their knee and do not wish to return to cutting and pivoting sports may decide not to have surgery. If they wish to remain active, they may engage in a different sport. However, patients who are left with an unstable knee or are enthusiastic about returning to their athletic activity of choice generally opt for revision surgery.

When considering whether or not to have a second ACL surgery, patients might want to ask their doctor the following questions:

Why was the first operation unsuccessful?
What will happen if I don’t have revision surgery?
Do I have any other knee injury, such as a torn cartilage, that may affect the outcome of revision surgery?
What will my recovery and rehabilitation be like?
What are the risks of surgery?
How can I avoid re-injuring my knee?

The best way to avoid revision ACL surgery in the first place is to do certain exercises to increase strength and balance. The other option is to stop playing cutting and pivoting sports, substituting other athletic activities in which the risk of ACL injury is low. Such activities include swimming, cycling, jogging and weight training.

Dr. Robert Marx is a sports medicine surgeon at Hospital for Special Surgery. He practices at both the HSS Outpatient Center in Stamford and the hospital’s main campus in New York.