Revision anterior cruciate ligament (ACL) reconstruction with bonepatellar tendon-bone graft through a round tunnel has been perceived as a reliable technique. Some patients present with marked expansion of the bone tunnel, but the most important point is to reconstruct the ACL within the anatomical footprint, followed addressing large bone defects. Preoperative three-dimensional planning can help in understanding the degree of bone defect and precise tunnel direction. Cartilage and meniscus damage at the time of surgery negatively affect subjective outcomes due to persistent pain and a low rate of return to original sporting activities. Surgical skill and flexibility are needed to tailor measures to the context of the individual patient.
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