Rehabilitation after revision anterior cruciate ligament reconstruction: Practice guidelines and procedure-modified, criterion-based progression

Reconstructive surgery has become a more common solution for patients after rupture of the anterior cruciateligament (ACL) as a result of better surgical technique and more efficient and effective rehabilitation. As the incidence of ACL reconstruction surgery increases, the number of reconstructions that ultimately fail also increases. Failure of the primary reconstruction, whether caused by technical error during the surgery or an outside factor such as traumatic rerupture, often necessitates revision of the ACL reconstruction to restore joint integrity and optimize function. We have previously described criterion-based and procedure-modified rehabilitation after primary ACL reconstruction. The same principles that drive rehabilitation after primary reconstruction are factors after revision surgery; however, the progression must be modified. The major difference between the two surgeries lies in the ability of the surgeon to achieve adequate fixation of the new graft within the joint during a revision reconstruction. The second controlled trauma of revision surgery further compromises the bony structures that serve as the foundation for the new graft. Therefore, less rigid fixation after revision ACL reconstruction must be assumed. This necessitates a longer period of controlled weight bearing for every-day activities and slower progression of weight-bearing exercise during rehabilitation to ensure that biological healing can proceed without being compromised by the presence of forces that exceed the strength of the new graft fixation. Other factors such as staging of the revision surgery and concurrent bony procedures will also require modification of the rehabilitation. Understanding these factors and implementing the modifications that they necessitate into rehabilitation should lead to a more predictable return to high functional levels after revision ACL reconstruction.