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Failure of anterior cruciate ligament reconstruction (ACLR) is a common yet devastating complication due to inferior clinical outcomes associated with revision ACLR. Identifying the cause and associated risk factors for failure is the most important consideration during preoperative planning. Special attention to tunnel quality, concomitant injuries, and modifiable risk factors will help determine the optimal approach and staging for revision ACLR. Additional procedures including lateral extra-articular tenodesis and osteotomy may be considered for at-risk populations. The purpose of this review is to explore causes of ACLR failure, clinical indications and appropriate patient evaluation, and technical considerations when performing revision ACLR., Competing Interests: Conflict of interest No Disclosure: S. Dadoo, N. Benvegnu, Z.J. Herman, T. Yamamoto, J.D. Hughes. V. Musahl. Education: Smith & Nephew, Arthrex, DePuy Synthes, Conmed. Consulting: Smith & Nephew, Newclip, Ostesys. Royalties: Springer. Shareholder: Ostesys. Board Member: ACL Study Group, AOSSM, ISAKOS, KSSTA (Deputy Editor-in-chief). Codeveloper of iPad app (Serial No. 61/566,761). NIH Grant Support: U01AR076144, W81XWH-16-PRORP-ICTA., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Patellar instability is a debilitating condition, and trauma due to the dislocations may severely damage the articular cartilage of the patellofemoral joint. The lack of healing capacity of cartilage makes treatment of such lesions challenging. In young patients, preservation of native bone and cartilage is a priority, and therefore arthroplasty procedures should be avoided even in relatively larger lesions. Fresh osteochondral allografting has been described for these difficult and complex cases, with recent studies showing promising results. In this surgical technique, we describe the use of bipolar osteochondral allografts of the patella and trochlea and patellofemoral joint reconstruction for large bipolar full-thickness cartilage defects due to recurrent dislocation events., (© 2019 Published by Elsevier on behalf of the Arthroscopy Association of North America.)