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Introduction: an increasing number of ACL revision reconstructions are executed each year. Different techniques (single- or double-bundle) and different grafts (autografts vs allografts) can be used. Revision with allograft tissue has the advantages of reducing donor site morbidity and allows versatility in choosing different approaches according to anatomical situation. The purpose of this study was to evaluate a novel revision double-bundle ACL reconstruction technique using an Achilles-tendon allograft. Material and methods: between 2002 and 2008, 30 patients underwent ACL revision surgery in our department by means of a fresh- frozen Achilles tendon non-anatomical double-bundle arthroscopic technique, with soft-tissue fixation by staples. The Achilles tendon was splitted to have a two bundle graft: one was passed Over-The-Top to reproduce the AM bundle and one inside the femoral tunnel to reproduce the PL bundle. Only one tibial tunnel was created. The mean patient age at surgery was 28.1±7.5 (range 18-46) years; the mean follow-up was 5.0±1.5 (range 3-10) years. Clinical evaluation was performed with Tegner Activity scale, Euro Qol 5 dimensions (EQ-5D) Score, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) evaluation form. Objective laxity measures were determined using a KT-1000 arthrometer. Magnetic Resonance Imaging (MRI) evaluation was used to assess the signal intensity of the graft at follow up. Results: the median Tegner score improved from 3 (range 3-4) to 6 (range 4-7) (P <0.0001). Moreover all other mean clinical scores improved significantly at follow-up: KOOS score (from 65.8±9.3 to 82.5±10.9, P<0.0001); EQ5D score (from 0.34±0.16 to 0.77±0.23, P<0.0001) and subjective IKDC (from 49.2±8.0 to 75.8±16.8, P<0.0001). The objective IKDC score improved from 2B,10C,18D to 6A,18B,4C,2D. KT-1000 manual maximum test side-to-side mean difference at follow-up was 3.0±2.2 mm. The 80% of patients returned to the same Tegner level prior to ACL primary reconstruction at a mean of 10.5±1.5 months after revision surgery. MRI evaluation revealed a good graft signal quality in 25 patients at follow-up. The failure rate at 5-year mean follow-up was 10% (5% re-injury, 5% instability). Conclusion: the presented technique combines the Achilles tendon allograft advantages to the possibility to perform an intrarticular double-bundle ACL reconstruction. Clinical results after revision ACL surgery are slightly inferior compared with those after primary ACL reconstruction. However at 5-year mean follow-up a good restoration of laxity and function was recorded in 80% of patients, with a low failure rate. [ABSTRACT FROM AUTHOR]