Surgical Predictors of Early Revision Surgery After Anterior Cruciate Ligament Reconstruction: Results From the Swedish National Knee Ligament Register on 13,102 Patients

Am J Sports Med. 2014 Jul;42(7):1574-82. doi: 10.1177/0363546514531396. Epub 2014 Apr 28.


Background: An important objective of anterior cruciate ligament (ACL) registries is to detect and report early graft failure and revision surgery after ACL reconstruction.

Purpose: To investigate surgical variables and identify predictors of revision surgery after ACL reconstruction.

Study design: Prospective cohort study; Level of evidence, 2.

Methods: This prospective cohort study was based on data from the Swedish National Knee Ligament Register during the years 2005 through 2011. Eight surgical variables were investigated: graft selection, graft width, single-bundle or double-bundle techniques, femoral graft fixation, tibial graft fixation, injury-to-surgery interval, injuries to menisci, and injuries to cartilage. The primary endpoint was the 2-year incidence of revision surgery. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated and adjusted for confounders by use of multivariate statistics.

Results: A total of 13,102 patients were included (5541 women [42%] and 7561 men [58%]; P < .001). Hamstring tendon autografts accounted for 90% (11,764 patients) of all reconstructions, of which 96% were performed with a single-bundle technique (11,339 patients). Patellar tendon autografts accounted for the remaining 10% (1338 patients). At index reconstruction, observed injuries to menisci and cartilage were common (40% and 28%, respectively). The overall 2-year incidence of revision surgery was 1.60% (women, 1.57%; men, 1.63%; P = .854). Patients with metal interference screw fixation of a semitendinosus tendon autograft on the tibia had a significantly reduced risk of early revision surgery (RR = 0.32; 95% CI, 0.12-0.90; P = .031).

Conclusion: Metal interference screw fixation of a semitendinosus tendon autograft on the tibia was an independent predictor of significantly lower 2-year incidence of revision surgery. Graft selection, graft width, a single-bundle or a double-bundle technique, femoral graft fixation, the injury-to-surgery interval, and meniscus injury were not predictors of early revision surgery.

Keywords: autografts; bone–patellar tendon–bone; epidemiology; graft failure; graft survival; hamstring tendon; knee injury; sports medicine; surgical revision.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Injuries
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Bone Screws
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Femur / surgery
  • Humans
  • Knee Joint / surgery*
  • Male
  • Middle Aged
  • Patellar Ligament / surgery
  • Prospective Studies
  • Registries
  • Reoperation / statistics & numerical data
  • Sweden
  • Tendons / transplantation*
  • Tibia / surgery
  • Transplantation, Autologous
  • Young Adult