➤ Technical errors such as nonanatomic tunnel placement are some of the most common causes of graft failure after primary anterior cruciate ligament reconstruction (ACLR).➤ When considering a revision ACLR in a patient with ACL graft failure, it is crucial to perform preoperative imaging, which should include an initial radiographic series, magnetic resonance imaging, and possibly computed tomography for further assessment of tunnel locations.➤ Revision ACLR may be performed in a 1 or 2-stage procedure depending on the size and location of the existing tunnels, bone stock, existing hardware, and infection status.➤ Use of autograft ligament tissue for revision ACLR has been shown to correlate with higher patient-reported outcomes and a significantly lower risk of subsequent graft rupture in comparison with allograft use.➤ Multiple studies have shown that the rate of return to the preinjury level of sport is significantly lower following revision ACLR than following primary ACLR procedures.