Anterior cruciate ligament reconstruction (ACL-R) is associated with high success rates in restoring knee stability; however, graft failure and recurrent instability occur in 0.7% to 20% of patients. ACL-R failure is a multifactorial process characterized by clinical findings such as instability, pain, and stiffness. Revision surgery represents a complex procedure with greater technical challenges and generally inferior outcomes compared to primary reconstruction. The aim of this review is to evaluate the multifactorial causes of ACL-R failure and to outline strategies for successful revision surgery. ACL-R failure can be classified into traumatic, technical, biological, and anatomical causes. Traumatic reinjury, particularly in young and active individuals, is the most common cause, accounting for 38–53% of failures. Technical factors include femoral and tibial tunnel malposition, inadequate graft fixation, and improper graft tensioning. Biological factors involve impaired graft incorporation, infection, and generalized joint laxity. In addition, meniscal injuries, lower limb malalignment, and increased posterior tibial slope contribute significantly to failure risk. Age under 25 years, posterior tibial slope greater than 12°, and generalized joint laxity have been identified as independent risk factors. Recent advances suggest that lateral extra-articular tenodesis improves rotational stability in high-risk patients, while vancomycin graft soaking reduces postoperative infection rates to near zero. In conclusion, prevention of ACL-R failure requires accurate identification of etiological factors, meticulous surgical technique, and individualized rehabilitation strategies.