Body Mass Index and the Risk of Repeat Revision Anterior Cruciate Ligament Reconstruction Failure

There is growing interest in understanding the correlates of revision anterior cruciate ligament reconstruction (ACLR) failure, and conflicting evidence exists regarding body mass index (BMI) as a risk factor.

To evaluate the relationship between BMI and revision ACLR failure.

Case-control study; Level of evidence, 3.

Patients aged 16 years or older who underwent revision ACLR between 2012 and 2021 with a minimum 2-year follow-up were included. Patients with inadequate follow-up, incomplete medical records, or concomitant lateral extra-articular tenodesis, anterolateral ligament reconstruction, osteotomy, osteochondral transplant, or multiligamentous injury were excluded. BMI was classified as normal (18.5 ≤ BMI < 25.0 kg/m²), overweight (25.0 ≤ BMI < 30.0 kg/m²), and obese 30.0 ≤ BMI < 35.0 kg/m²). Intraoperative data, concomitant injuries, complications, graft failure, and second revision ACLR data were collected.

A total of 174 patients who underwent revision ACLR were included; 37 (21.3%; 26 male, 11 female) experienced revision ACLR failure while 137 (78.7%; 83 male, 54 female) did not. The mean BMI did not differ between patients with and without revision ACLR failure. There was no difference in revision ACLR failure when stratifying patients by normal (n = 81), overweight (n = 57), or obese (n = 36) BMI.

There is no significant relationship demonstrated between BMI and the risk of revision ACLR failure.