Surgery

Risk factors for ACL revision failure and optimum graft size for revision anterior cruciate ligament reconstruction

Ethan Littlefield

25 Jun 2025 — 1 min read

PMCID: PMC12179230

PMID: 40536685

DOI: 10.1007/s00590-025-04381-7

Journal: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

Publication Date: 2025-6-19

Authors: Lu VY, Lee DH, Tsui SH, Lo TC, Chau WW, et al.

Key Points

Graft diameter < 9 mm significantly increases re-rupture risk in revision ACLR
16.7% of revision ACLR patients experienced graft re-rupture
Surgeons should carefully counsel patients about return to pivoting sports after revision surgery

Summary

This retrospective study investigated risk factors for graft re-rupture after revision anterior cruciate ligament reconstruction (ACLR), focusing on the critical clinical challenge of graft failure in secondary surgical interventions. Among 132 patients undergoing revision ACLR, the overall graft re-rupture rate was 16.7%, with a mean follow-up of 3.22 years. The research specifically examined how graft diameter and return to pivoting sports might influence re-injury risk.

Multivariate logistic regression analysis revealed two significant independent risk factors for graft re-rupture: graft diameter < 9 mm (OR: 3.873; 95% CI 1.128–13.293; p=0.031) and return to pivoting sports after revision surgery (OR: 4.105; 95% CI 1.008–16.721; p=0.049). Notably, contrary to potential expectations, concomitant knee pathologies such as meniscal or chondral lesions were not associated with increased re-rupture rates. These findings provide nuanced insights for surgeons planning revision ACLR, emphasizing the importance of graft sizing and patient activity modification.

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