Revision anterior cruciate ligament reconstruction following failure of combined anterior cruciate ligament reconstruction with lateral extra-articular procedures: A scoping review.

Abstract

Purpose: The purpose of this scoping review was to map the existing literature describing revision anterior cruciate ligament reconstruction (ACLR) following failure of combined ACLR with lateral extra-articular procedures (LEAPs), characterize reported surgical strategies, summarize available clinical outcomes and identify gaps in the current evidence base.

Methods: A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Ovid MEDLINE, Embase and PubMed were searched from inception to February 2026. Eligible studies included technical notes and clinical studies describing revision of failed combined ACLR with LEAPs, including lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALLR). Studies were included irrespective of outcome reporting, provided revision strategies were described. Single-revision or re-revision cases and adult and paediatric populations were included. Review articles, editorials and letters were excluded. Data were extracted and synthesized descriptively.

Results: Nine studies were included. Three studies described detailed revision strategies, including single-stage revision ACLR with ALLR, double-bundle revision ACLR with LET preservation and all-epiphyseal revision ACLR following failed LET. Six clinical studies included 594 patients within broader primary or revision ACLR cohorts, of whom 23 were explicitly identified as undergoing revision or re-revision following failure of a combined ACLR with LEAP. Revision strategies were heterogeneous in graft selection and management of the LEAP, including LET preservation, LET revision or conversion to ALLR. Clinical outcomes were reported in two case reports, both demonstrating satisfactory short-term stability and functional outcomes following revision ACLR with LET preservation.

Conclusions: The current literature on the revision of failed combined ACLR with LEAPs is limited and heterogeneous. Revision strategies vary widely, and reporting of both technique and clinical outcomes is inconsistent. Based on the limited evidence and expert opinion, revision ACLR in this context should be individualized according to surgeon experience and patient-specific factors, such as prior ACL graft harvest, tunnel interactions and the status of the prior LEAP.

Level of evidence: Level V.