Revision anterior cruciate ligament (ACL) surgery is considerably more complex than primary reconstruction, and its success largely depends on accurate assessment and management of the tibial tunnel. This review addresses the causes and classification of failure in revision ACL surgery, preoperative clinical and radiological assessment strategies, surgical techniques for managing tibial tunnel malposition and widening, factors influencing the single- versus two-stage revision decision, graft selection, tibial-sided fixation strategies, assessment and correction of posterior tibial slope and coronal malalignment, lateral extra-articular augmentation procedures, and management of concomitant meniscal and ligamentous pathologies, in light of current literature. Particular attention is given to controversial areas, including inconsistencies in the tunnel widening thresholds used in the literature and methodological differences in measuring posterior tibial slope. The aim of this review is to present current tibial tunnel-focused approaches within a systematic framework to support clinical decision-making.