Abstract Objective: To investigate the main reasons for revision surgery after anterior cruciate ligament (ACL) reconstruction failure. Methods: Clinical data of 36 patients admitted from March 2009 to March 2020 who underwent revision surgery due to ACL reconstruction failure were reviewed, including 31 males and 5 females, aged 29.5 (IQR 24.5-33.5) years old.The causes of ACL reconstruction failure were analyzed by combining the clinical cases and imaging data of the patients. Results: Among the 36 revision patients, autologous tendons were used for the initial reconstruction graft in 33 patients, allograft tendons were used in 2 patients, and LARS artificial ligaments were used in 1 patient. Among the failure factors of the initial ACL reconstruction in patients, 19 were caused by trauma; 10 cases were completely owing to technical reasons; 3 patients underwent revision due to biological reasons; 7 cases were combined factors, among which 6 cases had trauma history and technical factors at the same time, and 1 case had biological factors combined with technical factors. Another 3 cases were due to other causes. During revision surgery, autogenous tendons were used in 23 cases, LARS artificial ligaments were used in 10 cases, allograft tendons were used in 2 cases, and autograft tendons and allograft tendons were used in 1 case due to excessively thin autograft tendons (≤6mm). Conclusion: The factors contributing to failure of ACL reconstruction include selection of bone tunnel, graft selection and combined injury.