Revision ACL Reconstruction in Reading — Single-Stage and Two-Stage Surgery

Common reasons for graft failure

Patients often describe recurrent giving way, pain, or loss of confidence in the knee during twisting or pivoting movements. These symptoms can often be improved with a structured revision approach.

Single-stage vs two-stage revision ACL reconstruction

The decision between a single-stage or two-stage operation depends on the quality and position of the existing bone tunnels.

In a single-stage procedure, both the graft removal and new reconstruction are performed at the same time.

In some cases, the tunnels are too wide or poorly positioned, making it unsafe to place a new graft immediately. In these cases, Mr Nahas performs a two-stage reconstruction.

The two-stage process explained

The first stage involves bone grafting the old tunnel in the tibia (shin bone) and sometimes the femur. Mr Nahas often explains this with a simple analogy:

"If there's a hole in a wall where a screw once sat and you want to put up a new shelf, you can't just re-use the same damaged hole. You first need to fill it with polyfiller, let it harden, and then drill a fresh, strong hole for the new screw. ACL revision surgery follows the same principle — we graft the tunnel, let the bone heal, and then create a new, stable channel for the new ligament."

After the grafted bone has fully healed, typically a few months later, the second stage reconstruction is performed using the new, properly aligned tunnels.

Graft options for revision ACL surgery

Revision procedures require careful graft selection. Depending on previous grafts used, available tendons, and patient preference, options include:

• Autograft (using your own tissue)

• Allograft (using donor tissue from another person)

In some cases, particularly where previous grafts or tissues have already been used, an allograft may be the best option. All graft choices and their benefits are discussed with every patient in detail prior to surgery.

Advanced imaging for surgical planning

High-resolution MRI and sometimes CT scans are arranged to assess tunnel position and bone quality. This determines whether single- or two-stage surgery is required.

Patients benefit from rapid access to imaging — typically within a week of consultation.

Recovery pathway

The rehabilitation process after revision ACL reconstruction follows a similar timeline to primary ACL surgery.

Each patient follows a recovery pathway designed for safe healing and return to full activity. The recovery pathway is tailored to each individual's lifestyle and sporting goals. Recovery is criteria-based and not actually based on a fixed time. What this means is you are not allowed to progress to the next phase of rehabilitation if your knee or muscles are not ready. Each patient's timeline will differ depending on progress, and results are not guaranteed as per this timeline. These are approximate estimates.

Risks and complications

As with any operation, there are risks. Most patients have no serious problems, but it is important to know about them. Revision surgery carries some extra risks compared with a first ACL reconstruction.

Mr Nahas will go through the risks that apply to you at your consultation.

Expertise in complex and revision knee surgery

Self-pay pricing and rapid access

Self-pay patients can book directly for consultations within a week without a GP referral. Self-pay packages are available with transparent pricing.

Where surgery is performed

Revision ACL reconstruction is carried out at Circle Reading Hospital, with easy access from Berkshire, Wokingham, Henley, Oxford, Maidenhead, and Bracknell.