Rate and Timing of Revision and Contralateral Anterior Cruciate Ligament Reconstruction Relative to Index Surgery

After anterior cruciate ligament (ACL) reconstruction (ACLR), ipsilateral ACL graft reinjury or contralateral ACL injury has been reported. The rate and predictors of such subsequent ACL injuries have not been reported in recent years and in large patient cohorts.

The current study utilized a large, national, multi-insurance, administrative database to assess subsequent ACLR and factors associated with its occurrence.

Cross-sectional study; Level of evidence, 3.

Using the PearlDiver M151 database, patients who underwent ACLR within the United States between 2015 and 2021 were abstracted. All included patients had ≥3 years of evaluation after initial ACLR. Patients who underwent a subsequent reconstruction (ipsilateral or contralateral) within 3 years were determined and the timing assessed. Using univariable and multivariable logistic regression, the factors associated with having a subsequent ACLR and the factors associated with returning for ipsilateral versus contralateral ACLR were examined.

In total, 40,151 patients who underwent initial ACLR during the study period were identified. Of these, subsequent ACLR was performed for 1689 patients (4.2%). These included ipsilateral revision for 1018 (60.3%) and contralateral reconstruction for 671 (39.7%) patients. Patients returning for ipsilateral reconstruction did so sooner than patients needing a contralateral reconstruction. On multivariable analysis, the only factor independently associated with subsequent ACLR was younger age (odds ratio [OR] = 4.17 for 10-14 years relative to 25-29 years; P < .0001). Factors associated with returning for an ipsilateral revision ACLR as opposed to contralateral ACLR were earlier revision (OR = 1.49 within 1.5 years relative to after 1.5 years; P = .0001) and female sex (OR = 0.62 relative to male sex; P < .0001).

The overall rate of requiring a subsequent ACLR was found to be 4.2%, with 60.3% of these being to the ipsilateral ACL. This information may be helpful for evolving injury-prevention programs and patient counseling.