title: Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review.
abstract: BACKGROUND
  Injury to the ipsilateral graft used for reconstruction of the anterior cruciate ligament (ACL) or a new injury to the contralateral ACL is a devastating outcome following successful ACL reconstruction, rehabilitation, and return to sport. Little evidence exists regarding the intermediate to long-term risk of these events.
  
  
  METHODS
  The present study is a systematic review of Level-I and II prospective studies that evaluated the rate of rupture of the ACL graft and the ACL in the contralateral knee following a primary ACL reconstruction with use of a mini-open or arthroscopic bone-tendon-bone or hamstring autograft after a minimum duration of follow-up of five years.
  
  
  RESULTS
  Six studies met the inclusion and exclusion criteria. The ipsilateral ACL graft rupture rate ranged from 1.8% to 10.4%, with a pooled percentage of 5.8%. The contralateral injury rate ranged from 8.2% to 16.0%, with a pooled percentage of 11.8%.
  
  
  CONCLUSIONS
  This systematic review demonstrates that the risk of ACL tear in the contralateral knee (11.8%) is double the risk of ACL graft rupture in the ipsilateral knee (5.8%). Additional studies must be performed to determine predictors for these injuries and to improve our ability to avoid this devastating outcome.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. wright@wudosis.wustl.edu
authors.forename: Rick W
authors.initials: RW
authors.lastname: Wright
authors.forename: Robert A
authors.initials: RA
authors.lastname: Magnussen
authors.forename: Warren R
authors.initials: WR
authors.lastname: Dunn
authors.forename: Kurt P
authors.initials: KP
authors.lastname: Spindler
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery* / Q000637:transplantation; D000070598:Anterior Cruciate Ligament Injuries; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012421:Rupture / Q000601:surgery; D016896:Treatment Outcome