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Published on: September 2, 2025
Concomitant Intra-articular Injuries in 37,423 Primary and Revision ACL Reconstructions: A Systematic Review and
Tomás F Vega1, Napatpong Thamrongskulsiri1,2, Joseph C Brinkman1
1Rush University Medical Center, Chicago, Illinois, USA.
The American Journal of Sports Medicine
|May 12, 2026
Summary
Revision anterior cruciate ligament reconstruction (ACLR) shows significantly higher rates of meniscal tears and chondral lesions compared to primary ACLR. These findings highlight a greater intra-articular disease burden in revision cases.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanical Engineering
Background:
- Intra-articular lesions of menisci and cartilage are frequent following anterior cruciate ligament reconstruction (ACLR).
- The prevalence and nature of these injuries may differ between primary and revision ACLR procedures.
- Understanding these differences is crucial for predicting outcomes and planning surgical interventions.
Purpose of the Study:
- To systematically review and conduct a meta-analysis comparing the prevalence and risk factors of intra-articular injuries in primary versus revision ACLR.
- To quantify the differences in meniscal and chondral injury rates between primary and revision ACLR.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched PubMed, MEDLINE, and Embase databases, supplemented by citation review and author contact.
- Included comparative studies reporting intraoperative meniscal and/or chondral findings in both primary and revision ACLRs; calculated pooled odds ratios with 95% confidence intervals.
Main Results:
- Nineteen studies comprising 37,423 ACLRs were analyzed.
- Revision ACLR demonstrated higher odds of meniscal injury (OR, 1.64) and over 3-fold higher prevalence of chondral lesions (OR, 3.53), particularly in the trochlea, medial tibial plateau, and medial femoral condyle.
- High-grade chondral lesions were more common in revisions, with risk factors including older age, male sex, tunnel malposition, malalignment, increased tibial slope, and prior meniscectomy.
Conclusions:
- Revision ACLR is associated with significantly increased odds of both meniscal tears and chondral lesions compared to primary ACLR.
- Chondral injuries are more prevalent and severe in revision settings, affecting all compartments with the highest risk in the trochlea and medial compartment.
- A substantially greater intra-articular disease burden exists at the time of revision ACLR surgery.