In recent years, with the development of arthroscopic technology, the technique of arthroscopic ACL reconstruction surgery has developed rapidly, and the number of cases has increased significantly year by year. Although the long-term follow-up success rate of ACL reconstruction surgery is high, however, there are still a considerable number of cases that require revision surgery because of the failure of reconstruction due to the surgeon’s surgical technique or the patient’s re-injury. The causes of ACL reconstruction surgery failure, technical requirements for revision surgery, and selection of grafts are outlined here. The causes of failure of ACL reconstruction surgery are mainly the following: 1. Preoperative multiple ligament injuries or compound injuries; simple ACL reconstruction does not completely solve the problem. 2. Surgical technical errors 3. Postoperative infection 4. Failure of graft combination 5. Poor postoperative rehabilitation exercise 6. Postoperative re-trauma II. What to do after initial surgical ligament failure? For a case of ACL reconstruction failure, the first step is to clarify the cause of failure as much as possible and determine whether revision surgery is needed. In cases where revision is determined to be necessary, consideration should be given to whether the surgery can be completed in one phase or in two phases of reconstruction, such as cases of failure due to infection or cases with a large number of bone defects that may require staging. A detailed and adequate surgical plan should be developed for the individual patient. The choice of the revision ligament The choice of the revision ligament should not only be combined with the use of the initial ligament, but also take into account the problems of the graft ligament itself. At present, the anterior cruciate ligament revision can choose the contralateral limb tendon, allograft tendon or artificial ligament. 2. Rehabilitation exercise requirements The rehabilitation after the initial ACL reconstruction is mostly advocated by the rapid progress method, while the rehabilitation training after the revision needs to be combined with the graft material used, the bone tract defect, the fixation strength and the stability of the affected knee, and be carried out in a progressive manner with the full support and cooperation of the patient. In conclusion, revision of a failed ACL reconstruction is much more complex than the initial reconstruction surgery and requires not only a clear understanding of the cause of failure, detailed planning, thorough preparation, and good revision surgery techniques, but also a full understanding that revision surgery is intended as a remedial measure to reduce the impact on the patient’s daily life, not to restore his or her pre-injury activity.