Anterior cruciate ligament reconstruction is one of the most common procedures performed in sports medicine centers. However, these procedures can carry a long-term failure rate as high as 5-15%%, and when these procedures fail, revision is significantly more complex. Considerable factors need to be assessed in patients that are indicated for surgery, as revisions carry a higher failure rate and potentially less optimal outcomes and return to sport and activity. These factors include, but are not limited to, the status of the meniscus, overall alignment, graft options, placement of prior implants or tunnels, collateral ligament quality, and whether or not the revision must be staged into two procedures.  <div> </div><div>This text provides a comprehensive, case-based presentation of the most efficient and practical treatment algorithms for patients in need of revision ACL repair and reconstruction.