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Cited by 628Knee injuries and reconstruction techniquesFoot and Ankle SurgerySports injuries and prevention

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Risk Factors and Predictors of Subsequent ACL Injury in Either Knee After ACL Reconstruction: Prospective Analysis of 2488 Primary ACL Reconstructions From the MOON Cohort

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Kaeding, Christopher C., Pedroza, Angela D., Reinke, Emily K., Huston, Laura J., MOON Consortium, Spindler, Kurt P., Amendola, Annunziato, Andrish, Jack T., Brophy, Robert H., Dunn, Warren R., Flanigan, David, Hewett, Timothy E., Jones, Morgan H., Marx, Robert G., Matava, Matthew J., McCarty, Eric C., Parker, Richard D., Wolcott, Michelle, Wolf, Brian R., Wright, Rick W.·2015·The American Journal of Sports Medicine
DOI 10.1177/0363546515578836PMC PMC4601557
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Abstract

Background: Anterior cruciate ligament (ACL) reinjury results in worse outcomes and increases the risk of posttraumatic osteoarthritis. Purpose: To identify the risk factors for both ipsilateral and contralateral ACL tears after primary ACL reconstruction (ACLR). Study Design: Cohort study; Level of evidence, 3. Methods: Data from the Multicenter Orthopaedic Outcomes Network (MOON), a prospective longitudinal cohort, were used to identify risk factors for ACL retear. Subjects with primary ACLR, no history of contralateral knee surgery, and a minimum of 2-year follow-up data were included. Age, sex, Marx activity score, graft type, lateral meniscal tear, medial meniscal tear, sport played at index injury, and surgical facility were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. Results: A total of 2683 subjects with average age of 27 ± 11 years (1498 men; 56%) met all study inclusion/exclusion criteria. Overall there were 4.4% ipsilateral graft tears and 3.5% contralateral ACL tears. The odds of ipsilateral ACL retear were 5.2 times greater for an allograft ( P < .01) compared with a bone–patellar tendon–bone (BTB) autograft; the odds of retear were not significantly different between BTB autograft and hamstring autograft ( P = .12). The odds of an ipsilateral ACL retear decreased by 0.09 for every yearly increase in age ( P < .01) and increased by 0.11 for every increased point on the Marx score ( P < .01). These odds were not significantly influenced by sex, smoking status, sport played, medial or lateral meniscal tear, or consortium site ( P > .05). The odds of a contralateral ACL tear decreased by 0.04 for every yearly increase in age ( P = .04) and increased by 0.12 for every increased point on the Marx score ( P < .01); these odds were not significantly different between sex, smoking status, sport played, graft type, medial meniscal tear, or lateral meniscal tear ( P > .05). Conclusion: Younger age, higher activity level, and allograft graft type were predictors of increased odds of ipsilateral graft failure. Higher activity and younger age were found to be risk factors in contralateral ACL tears.

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  • Clinicians use objective factors such as age, time from injury, and strength symmetry in clinical decision-making for return to sport after ACLR; however, these alone do not fully explain why some athletes do not return to sport despite achieving adequate physical rehabilitation.

    “Clinicians use objective factors such as age, time from injury, and strength symmetry in clinical decision-making for return to sport after ACLR5–11; however, these alone do not fully explain why some athletes do not return to sport despite achieving adequate physical rehabilitation.12–15”

    From Determinants of Psychological Readiness to Return to Sport After Anterior Cruciate Ligament Reconstruction (2026) · cites this paper as [6]

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Metadata

Authors
Kaeding, C. C., Pedroza, A. D., Reinke, E. K., Huston, L. J., MOON Consortium, Spindler, K. P., Amendola, A., Andrish, J. T., Brophy, R. H., Dunn, W. R., Flanigan, D., Hewett, T. E., Jones, M. H., Marx, R. G., Matava, M. J., McCarty, E. C., Parker, R. D., Wolcott, M., Wolf, B. R., & Wright, R. W.
Affiliations
  • The Ohio State University (US)
  • Vanderbilt University Medical Center (US)
  • Cleveland Clinic (US)
ORCID
Venue
The American Journal of Sports Medicine
Publisher
SAGE Publications
Published
2015-04-21
Volume
43
Issue
7
Pages
1583-1590
ISSN
  • 0363-5465 (ISSN-L)
  • 1552-3365
DOI
10.1177/0363546515578836
PMC
PMC4601557
OpenAlex
W2163295045
Cited by
628
References
0
Citations by year
2026: 46 · 2025: 56 · 2024: 72 · 2023: 71 · 2022: 64 · 2021: 62 · 2020: 51 · 2019: 60 · 2018: 52 · 2017: 57 · 2016: 31 · 2015: 6
FWCI
46.90
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • The American Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23AR052392, R01AR053684)
Topics
  • Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
Keywords
anterior cruciate ligament reconstruction, ACL reinjury, graft failure, bone-patellar tendon-bone autograft, hamstring tendon graft, age as risk factor, meniscal tears, post-traumatic osteoarthritis
MeSH terms
Anterior Cruciate Ligament Injuries, Adolescent, Adult, Female, Humans, Knee Injuries, Knee Joint, Longitudinal Studies, Male, Osteoarthritis, Prospective Studies, Risk Factors, Transplantation, Autologous, Cohort Studies, Patellar Ligament, Muscle, Skeletal, Young Adult, Anterior Cruciate Ligament Reconstruction

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