Single-stage revision anterior cruciate ligament reconstruction (ACLR) is an alternative to two-stage surgery in appropriately selected patients after failure of primary reconstruction; however, it requires comprehensive assessment and individualized planning. This review aims to evaluate current patient-selection criteria, preoperative assessment, surgical indications, and technical options for single-stage revision ACLR. Failure of the primary procedure may result from technical error, traumatic reinjury, biological failure, or unrecognized concomitant pathology. Standard radiographs and magnetic resonance imaging provide complementary information, whereas three-dimensional computed tomography is the key modality for assessing the position, diameter, orientation, and bone stock of the femoral and tibial tunnels. Patients are suitable candidates when existing tunnels can be reused or new anatomic tunnels can be created safely, adequate bone stock is available, and active infection or severe arthrofibrosis is absent. Graft choice, tunnel management, and fixation should be individualized. Risk factors such as high-grade rotational instability, meniscal deficiency, associated ligament injury, and increased posterior tibial slope should be identified and treated with adjunctive procedures when indicated. When appropriate indications and anatomic reconstruction are achieved, a single-stage approach may avoid a second operation, shorten treatment and rehabilitation, and reduce morbidity. Conversely, substantial bone loss, critical tunnel overlap, active infection, or inability to obtain secure fixation generally favors a two-stage strategy.