Introduction Failure of ACL reconstruction rather than another trauma can be due to preoperative, operative, and postoperative factors which might not be addressed during the initial surgery. The presence of genu varus is an important factor of unsatisfactory results and even ACL surgery failure. The presence of varus deformity eventually leads to degenerative arthritis of the medial compartment which will be a source of chronic knee pain [1]; also, the presence of varus deformity will increase the tension on the newly reconstructed ACL which will predispose to ACL graft failure [1,2]. The role of the anterolateral ligament (ALL) in the rotational stability of the knee is not overemphasized. Anterolateral ligament injury associated with an ACL injury will be a source of postoperative rotational overload and graft failure despite perfect anatomical positioning and secure fixation of the graft [3]. To optimize the results of ACL revision surgery, a triple procedure is suggested; concomitant ACL regrafting, open medial wedge high tibial osteotomy, and anterolateral ligament reconstruction. This suggested combination will improve the outcome of the revision cases as it increases the rotational stability, decreases the tension on the newly inserted graft, and decreases the incidence of later degenerative arthritis