<p>Chronic instability following multiple previous surgeries is often challenging. A detailed medical history and comprehensive clinical examination are essential to precisely assess the clinical picture. Symptoms must be conclusively assigned to the clinical findings and imaging results. If recurrent instability occurs, especially after multiple failed ligament reconstructions, there is often a combination of several pathological factors. These include pronounced ligamentous instability, meniscus damage, a pathologically increased tibial slope, axial deformities in the frontal plane, degenerative changes, and deficits in muscle function. These multifactorial influences significantly increase the risk of renewed rupture and often make revision surgery technically complex and challenging. Against this background, the indication for additional procedures—such as extra-articular tenodesis or a slope-reducing osteotomy—must be carefully considered. Not all pathological findings can always be completely addressed in a single surgical procedure. In many cases, compromise is necessary and complete relief of symptoms is not always realistic. In many cases, adequately addressing the underlying pathological factors enables a substantial functional improvement of the knee joint and relevant symptom relief.</p>