title: ACL Graft and Contralateral ACL Tear Risk within Ten Years Following Reconstruction: A Systematic Review.
abstract: BACKGROUND
  Anterior cruciate ligament (ACL) graft tear and contralateral ACL injury have devastating effects on patient outcomes following ACL reconstruction. Long-term results after ACL reconstruction are being reported with greater frequency, allowing a detailed analysis of the long-term risk of failure.
  
  
  METHODS
  A systematic review of prospective studies that recorded the risk of ACL graft rupture and contralateral ACL injury following primary ACL reconstruction was performed. All studies included intra-articular ACL reconstruction with modern techniques and patellar tendon or hamstring autograft with a minimum follow-up of ten years.
  
  
  RESULTS
  Nine studies met the inclusion and exclusion criteria. The overall ACL graft rupture risk was 7.9% (211 ruptures in 2682 reconstructions) and ranged from 3.2% to 11.1% in the individual studies. The overall risk of ACL injury in the contralateral limb was 12.5% (335 injuries in 2682 reconstructions) and ranged from 0.6% to 22.7% in the individual studies. Among the seven homogeneous studies that were pooled, the overall risk of a contralateral ACL tear was 1.63 (95% confidence interval [CI]: 1.30 to 2.04) times that of a graft tear during the follow-up period.
  
  
  CONCLUSIONS
  At a minimum follow-up time of ten years, the risk of contralateral ACL tear significantly exceeds the risk of ACL graft rupture. Further work is necessary to understand and potentially reduce this risk of graft and contralateral ACL tears.
  
  
  METHODS
  Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedics (R.A.M., N.T.M., and C.C.K.) and Sports Health and Performance Institute (R.A.M. and C.C.K.), The Ohio State University Medical Center, 2050 Kenny Road, Suite 3100, Columbus, OH 43221.
authors: Robert A
authors: RA
authors: Magnussen
authors: Department of Orthopaedics (R.A.M., N.T.M., and C.C.K.) and Sports Health and Performance Institute (R.A.M. and C.C.K.), The Ohio State University Medical Center, 2050 Kenny Road, Suite 3100, Columbus, OH 43221.
authors: Nicole T
authors: NT
authors: Meschbach
authors: Department of Orthopaedics (R.A.M., N.T.M., and C.C.K.) and Sports Health and Performance Institute (R.A.M. and C.C.K.), The Ohio State University Medical Center, 2050 Kenny Road, Suite 3100, Columbus, OH 43221.
authors: Christopher C
authors: CC
authors: Kaeding
authors: Department of Orthopaedic Surgery, Washington University, St. Louis, MO.
authors: Rick W
authors: RW
authors: Wright
authors: Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH.
authors: Kurt P
authors: KP
authors: Spindler
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery / Q000637:transplantation; D000070598:Anterior Cruciate Ligament Injuries / Q000453:epidemiology / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012421:Rupture; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000706:statistics & numerical data; D019737:Transplants / Q000706:statistics & numerical data; D055815:Young Adult