Anterior cruciate ligament (ACL) injuries are common in athletes, and the need for revision surgery is increasing, particularly in the young and active population. Revision ACL surgery in athletes is a significantly more complex process than primary surgery due to bone stock loss, concomitant meniscus/cartilage damage, and altered biomechanical axes. Accurate analysis of the causes of initial failure (technical errors, post-surgical trauma, unrecognized pathologies) is essential for a successful revision. This review examines the reasons of primary failure, challenges and current surgical strategies in revision surgery. Preoperative imaging, the decision between one-stage versus two-stage surgery based on tunnel management (including innovative approaches like the Kocabey press-fit technique), appropriate graft selection, meniscus management, and the necessity of extra-articular procedures are detailed. Additionally, the correction of bony deformities and return-to-sport criteria are discussed. In conclusion, revision surgery requires personalized planning and a multifactorial approach.