Ipsilateral Graft Rupture Research Articles

What it takes to have a high-grade pivot shift-focus on bony morphology.

Variations in femoral and tibial bony morphology have been associated with higher clinical grading and increased quantitative tibial translation, but not tibial acceleration, during the pivot shift test following anterior cruciate ligament (ACL) injury. The purpose of this study was to determine the impact of femoral and tibial bony morphology, including a measurement influenced by both parameters (the Lateral Tibiofemoral Articular Distance (LTAD)), on the degree of quantitative tibial acceleration during the pivot shift test and rates of future ACL injury. All patients who underwent primary ACL reconstruction from 2014 to 2019 by a senior orthopedic surgeon with available quantitative tibial acceleration data were retrospectively reviewed. All patients underwent a pivot shift examination under anesthesia with a triaxial accelerometer. Measurements of femoral and tibial bony morphology were performed by two fellowship-trained orthopedic surgeons using preoperative magnetic resonance imaging and lateral radiographs. Fifty-one patients were included at a mean follow-up of 4.4years. The mean quantitative tibial acceleration during the pivot shift was 13.8m/s2 (range: 4.9-52.0m/s2). A larger Posterior Condylar Offset Ratio (r = 0.30, p = 0.045), smaller medial-to-lateral width of the medial tibial plateau (r = -0.29, p = 0.041), lateral tibial plateau (r = -0.28, p = 0.042), and lateral femoral condyle (r = -0.29, p = 0.037), and a decreased LTAD (r = -0.53, p < 0.001) significantly correlated with increased tibial acceleration during the pivot shift. Linear regression analysis demonstrated an increase in tibial acceleration of 1.24m/s2 for every 1mm decrease in LTAD. Nine patients (17.6%) sustained ipsilateral graft rupture and 10 patients (19.6%) sustained contralateral ACL rupture. No morphologic measurements were associated with rates of future ACL injury. Increased convexity and smaller bony morphology of the lateral femur and tibia were significantly associated with increased tibial acceleration during the pivot shift. Additionally, a measurement, termed the LTAD, was found to have the strongest association with increased tibial acceleration. Based on the results of this study, surgeons can utilize these measurements to preoperatively identify patients at risk of increased rotatory knee instability. Level IV.

The pathological technical and tactical movements of a soccer player during return to sport predicts a second anterior cruciate ligament injury

Background: Return to sport after Anterior Cruciate Ligament (ACL) reconstruction remains a difficult decision-making process that is not structured on shared and homogeneous assessments. This greatly elevates the risk factors for second injuries. Objective: Highlight football-specific gestural, pathological, technical-tactical patterns that contribute to new ACL injuries (ipsilateral graft rupture or contralateral rupture of the native ACL). Material and method: For the purpose of this literature review, peer-reviewed and nonpeer-reviewed indexed journals were consulted from 1979 to the present. Studies were identified by searching them on PubMed/MEDLINE databases. The following search terms were used: “second ACL injury,” “cutting maneuver and ACL”, “sidestep cutting technique and ACL” “Valgus knee in sport” “change of direction and ACL injury” “pressing soccer” tackle in soccer”. The literature search was directed, also, to the Gray Literature. Result: An immediate pressing or re-aggression on the adversary, tackle, or cutting maneuver is clinically read as moments of risk factors, injury, or re-injury, for both the ball bearer and the defender. We found how a good deal of literature emphasizes how side-to-side gestural asymmetries, during technical and tactical movements, present during return to sport can elevate risk factors for second ACL injuries. During ball recovery, 4 main game situations have been found to elevate the risk factors of knee capsular ligament injuries: (1) during tactical moments of collective pressing or individual pressure; (2) in the postural rebalancing phase after moments of instability following the kicking of the ball; (3) dysfunctional moments from gestural instability, in landing, after a header in single-pedal support; (4) during a tackle by direct contact or indirect contact on the joint. Conclusion: Residual pathological movement’s side-to-side asymmetries and postural-dysfunctional pictures related to specific gestures after ACL reconstructive surgery are predictive factors of second ipsilateral ACL injury or injury to the contralateral limb. Given, however, the subjective interpretation of movement quality assessments, their relative reliability and validity in the diagnostic and therapeutic use of complex sports gestures, pressing, and cutting maneuvers, during the process of return to sport should be analyzed together and clinical assessments to identify other and consistent predictors of second ACL injuries.

Clinical Outcomes and Postoperative Complications After All-Epiphyseal Double-Bundle ACL Reconstruction for Skeletally Immature Patients.

Background:The treatment strategy for pediatric anterior cruciate ligament (ACL) tears, especially in patients with open physes, remains controversial.Purpose:To assess clinical outcomes and postoperative complications after all-epiphyseal double-bundle ACL (DB-ACL) reconstruction for patients with open physes.Study Design:Cohort study; Level of evidence, 3.Methods:Included were 102 patients aged ≤15 years who underwent ACL reconstruction at a single institution and had a minimum of 2 years of follow-up. Of these patients, 18 had undergone all-epiphyseal DB-ACL reconstruction (mean age, 12.4 ± 1.2 year) and 84 had undergone conventional DB-ACL reconstruction (mean age, 14.1 ± 0.9 year). The outcomes of the all-epiphyseal group were compared with those of the conventional group. Objective clinical outcomes included KT-1000 arthrometer measurements of side-to-side difference in anterior tibial translation, Lachman test grade, and pivot-shift test grade. Radiographic angular deformity (defined as >3° of the side-to-side difference in femorotibial angle) and incidence of second ACL injury were also compared.Results:The postoperative side-to-side difference in laxity significantly improved from 6.1 ± 2.4 to 0.6 ± 0.9 mm in the all-epiphyseal group (P = .001), and postoperative laxity was similar to that of the conventional group (0.4 ± 0.8 mm; P = .518). A Lachman grade 1 positive result was observed in 20% of the all-epiphyseal group and 3% of the conventional group (P = .042), and a pivot-shift grade 1 positive result was observed in 22% of the all-epiphyseal group and 4% of the conventional group (P = .074). A total of 4 patients (26.7%) in the all-epiphyseal group and 4 (6.1%) in the conventional group demonstrated angular deformity (P = .035). The incidence of postoperative ipsilateral ACL tear was 16.7% in the all-epiphyseal group and 23.8% in the conventional group (P = .757). The incidence of contralateral ACL tear was 11.1% in the all-epiphyseal group and 14.3% in the conventional group (P ≥ .999).Conclusion:All-epiphyseal DB-ACL reconstruction for skeletally immature patients achieved satisfactory clinical outcomes compared with conventional DB-ACL reconstruction. The incidence of ipsilateral graft rupture was relatively high in both groups. The all-epiphyseal group had a significantly higher incidence of angular deformity.

Reduced 2-D Frontal Plane Motion During Single-Limb Landing Is Associated With Risk of Future Anterior Cruciate Ligament Graft Rupture After Anterior Cruciate Ligament Reconstruction and Return to Sport: A Pilot Study.

To evaluate the association between 2-D frontal plane movement and second anterior cruciate ligament (ACL) injury risk in young athletes at return to sport (RTS) after ACL reconstruction. Prospective cohort. Forty-nine participants who had ACL reconstruction (mean ± SD age, 16.5 ± 3.0 years) performed a single-leg drop landing from a 31-cm box at the time of their RTS. Frontal plane trunk, pelvis, and knee angles were measured using 2-D video analysis at the point of maximum depth during landing. Summated frontal plane angles were calculated by adding trunk, pelvis, and knee angles. Participants were grouped based on whether or not they sustained an ACL graft rupture over the 24 months after RTS. Seven participants (14%) sustained an ipsilateral graft rupture within 24 months after RTS. Participants who suffered a second ACL injury had a significant reduction in the summated frontal plane angle of the trunk, pelvis, and knee (P = .018) and of the trunk and knee (P = .02) compared to those who did not suffer a second injury. For every 5° increase in the summated trunk, pelvis, and knee angle (odds ratio [OR] = 0.54; 95% confidence interval [CI]: 0.31, 0.94) and the summated trunk and knee angle (OR = 0.48; 95% CI: 0.25, 0.94), the athletes were 46% to 52% less likely to sustain a graft rupture. Athletes who suffered an ACL graft rupture within 24 months of RTS had a more rigid posture when landing compared to their uninjured peers. The results of this pilot study should be replicated in a larger sample to determine whether this method has merit as a screening tool to identify athletes at high risk for second ACL injury. J Orthop Sports Phys Ther 2021;51(2):82-87. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9302.

Predictors for Anterior Cruciate Ligament (ACL) Re-injury after Successful Primary ACL Reconstruction (ACLR).

Introduction:Few authors have addressed risk factors related to an ipsilateral graft rupture and contralateral anterior cruciate ligament (ACL) injury after return to sports (RTS) following primary ACL reconstruction.Material and Methods:Patients with ACL re-injury to either knee after successful primary ACLR were included in Group I and those with no further re-injury were included in Group II. Variables including age, gender, side, body mass index (BMI), thigh atrophy, anterior knee laxity difference between both knees measured by KT-1000 arthrometer, mean time of return to sports (RTS), graft type, type of game, mode of injury, Tegner Activity Score, hormone levels, femoral tunnel length (FTL), posterior tibial slope (PTS) and notch width index (NWI) were studied. Binary logistic regression was used to measure the relative association.Results:A total of 128 athletes were included with 64 in each group. Mean age in Group I and II were 24.90 and 26.47 years respectively. Mean follow-up of Group I and Group II were 24.5 and 20.11 months respectively. Significant correlation was present between ACL re-injury and following risk factors; PTS of >10º, KT difference of >3.0mm, thigh atrophy of >2.50cm and time to RTS <9.50 months P value <0.05). No correlation was found with age, sex, BMI, type of game, Tegner Activity Score, mode of injury, NWI, size of graft, FTL and hormone levels.Conclusion:Possible risk factors include PTS of ≥ 10º, KT difference of ≥ 3.0mm at 1 year follow-up, thigh atrophy of ≥ 2.50cm at 1 year follow-up and RTS <9.5 months after primary ACLR.

COST-EFFECTIVENESS FOR RETURN-TO-PLAY (RTP) PROGRAMS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Background:Rupture of the anterior cruciate ligament (ACL) is a common injury in young athletes. Safe return-to-play (RTP, i.e. sports competition) is important to patient satisfaction, and appropriate criteria for RTP may reduce the risk of graft injury.Purpose:The purpose of this study is to assess the cost-effectiveness of a comprehensive RTP rehabilitation protocol relative to standard post-ACL reconstruction rehabilitation.Methods:A decision-analysis model was utilized to compare standard rehabilitation with an RTP program which included supplemental neuromuscular retraining, functional testing, and clinical follow-up. Cost-effectiveness was evaluated from a payer perspective. Costs of surgical procedures and rehabilitation protocols, risks of ipsilateral graft rupture and contralateral ACL injury, risk reductions due to the RTP program, and relevant utilities based on International Knee Documentation Committee (IKDC) outcomes were derived from the available literature. An incremental cost-effectiveness ratio (ICER) of <$100,000/QALY was used to determine cost-effectiveness. Sensitivity analyses were performed on pertinent model parameters to measure their effect on base-case conclusions. In the base-case analysis, the cost of an RTP program was conservatively assumed to be $1,721 more than the standard rehabilitation protocol. The relative risk of ACL graft rupture following completion of the RTP program was assumed to be 0.75 (25% reduction).Results:In the base-case analysis, the RTP program was cost-effective compared with the standard rehabilitation protocol (ICER $54,939/QALY). Based on one-way threshold analyses, the RTP program was cost-effective as long as the additional cost was <$2,092 or the RTP program decreased the incidence of graft rupture by >7.7%.Conclusion:Our data suggests that, assuming modest associated decreases in graft failure, the addition of neuromuscular retraining, functional testing, and clinical follow-up to a formal rehabilitation program is cost-effective. The cost-effectiveness of such additions is related to the costs as well as any associated decreases in subsequent event risk, as shown in Figure 1.Figures:Figure 1.Two-way sensitivity analysis of the additional cost of an RTP program (relative to standard rehabilitation) versus the relative risk of graft rupture following completion of an RTP program. The black line represents the base-case assumption of additional cost of an RTP program ($1,721). The white line represents the base-case assumption of the relative risk of graft rupture following completion of an RTP program (0.75).

Femoral nerve block at time of ACL reconstruction causes lasting quadriceps strength deficits and may increase short-term risk of re-injury.

To determine whether femoral nerve blockade (FNB) at the time of primary ACL reconstruction is associated with meeting isokinetic extension strength return to sport criteria near completion of physical therapy and whether FNB affects 1-year or 2-year risk of ipsilateral ACL graft rupture or contralateral native ACL injury. Three-hundred and sixty patients (n = 244 with FNB, n = 116 no FNB) underwent primary ACL reconstruction. All patients completed rehabilitation and underwent functional strength testing towards the end of knee rehabilitation (mean 5.6months post-surgery). Association between FNB and isokinetic extension strength limb symmetry index (LSI) (goal LSI ≥ 90% for return to sport) as well as risk of recurrent ACL injury within first or second year after surgery was evaluated. Ipsilateral or contralateral ACL injury within 2years occurred in 11.2% of patients with FNB and 5.7% without FNB (p = 0.01). Patients with FNB had higher incidence of ipsilateral graft rupture within the first year after surgery but no difference in graft rupture during the second. Two-year risk of contralateral ACL injury was similar in both groups. At the time of initial testing, patients who received FNB had lower fast isokinetic extension LSI versus patients without FNB and were less likely achieve a goal ≥ 90% LSI; slow extension LSI was unaffected. Use of FNB at the time of primary ACL reconstruction can negatively affect achievement of isokinetic extension strength return to sport criteria. FNB increases risk of graft rupture within the first year after surgery but does not affect re-injury risk during the second. FNB may not be appropriate for use in patients already at high risk of ACL re-injury. III.

Patient-Related Risk Factors for Contralateral Anterior Cruciate Ligament (ACL)Tear After ACL Reconstruction: An Analysis of 3707 Primary ACL Reconstructions.

Return to play after anterior cruciate ligament (ACL) reconstruction can increase risk for both ipsilateral graft rupture and contralateral ACL rupture. The risk for injury of the contralateral knee after ACL reconstruction could be nearly double that of ipsilateral graft rupture. We sought to identify independent, patient-related risk factors for contralateral ACL rupture following primary ACL reconstruction. A national database was queried for patients who underwent primary ACL reconstruction from 2007 to 2015 with a minimum of 2 years of post-operative follow-up (n = 12,044). Patients who underwent subsequent primary ACL reconstruction on the contralateral extremity were then identified. A multivariate binomial logistic regression analysis was utilized to evaluate patient-related risk factors for contralateral ACL rupture, including demographic and comorbidity variables. Adjusted odds ratios and 95% confidence intervals were calculated for each risk factor. Of the 3707 patients who had a minimum of 2 years of database activity and comprised the study group, 204 (5.5%) experienced a contralateral ACL rupture requiring reconstruction. Independent risk factors for contralateral ACL rupture included age less than 20 years, female gender, tobacco use, and depression. Obesity, morbid obesity, type 1 diabetes, type 2 diabetes, and a history of anxiety were not significant predictors of contralateral injury. We were able to adequately power an analysis to identify several significant patient-related risk factors for contralateral ACL rupture after primary ACL reconstruction, including younger age, female gender, tobacco use, and depression. This information can be used to counsel patients on the risk of injury to the contralateral knee.

Is anterior cruciate ligament graft rupture (after successful anterior cruciate ligament reconstruction and return to sports) actually a graft failure or a re-injury?

The objective of this study is to discuss the fact that whether graft rupture after successful anterior cruciate ligament (ACL) reconstruction surgery is due to graft failure or re-injury to the reconstructed ACL. In total, 340 sportspersons, meeting our inclusion criteria, were assessed for rupture of ipsilateral ACL graft and ACL injury of the contralateral knee. Patients with ipsilateral ACL graft rupture were labelled as group 1, while those with contralateral ACL injury were labelled as group 2. Both groups were compared for potential risk factors for ACL injury, and statistical analysis was performed to study whether the graft acted as an additional risk factor. Of the 340 sportspersons, 25 patients suffered a total of 26 injuries. Ipsilateral graft rupture rate was 2.4% (8 of 340) at a mean follow-up of 25.5 ± 40.57 months, and the contralateral ACL injury rate was 5.3% (18 of 340) at a mean follow-up of 18.11 ± 19.97 months, with an overall re-injury rate of 7.6%. Both groups were comparable for risk factors for ACL injury: age ( p = 0.255), gender ( p = 0.534), mode of re-injury ( p = 0.523), level of sports activity, type of graft used ( p = 0. 918), graft diameter ( p = 0.607), duration from injury to index surgery ( p = 0.492), duration from index surgery to re-injury ( p = 0.638), timing of return to sports after index surgery ( p = 0.303), duration of sporting activity before second injury ( p = 0.657), and Tegner's level of sports activity ( p = 0.486). Because the rate of contralateral ACL injury is higher than the ipsilateral graft rupture and the risk factors for ACL injury are comparable in both groups at a follow-up period, which is suggestive of ligamentization of the graft, we suggest that it might be an ACL re-injury rather than graft failure. Level of Evidence: Level III (Retrospective cohort study).

Are Female Soccer Players at an Increased Risk of Second Anterior Cruciate Ligament Injury Compared With Their Athletic Peers?

Background: Female soccer players have a well-known risk for anterior cruciate ligament (ACL) injury, but few studies have reported on second ACL injuries in this population. Purpose: To (1) report the rates of subsequent ACL injury (ipsilateral graft rupture or contralateral tear) in competitive female soccer players, (2) compare these rates with those of other female athletes of similar competitive level, (3) determine risk factors for second ACL injury, and (4) report clinical outcome scores in this population. Study Design: Cohort study; Level of evidence, 3. Methods: The medical records at a single institution were reviewed for female patients who were injured during a competitive athletic event and treated with primary ACL reconstruction (ACLR) between 1998 and 2013. Patients were followed for a mean of 68.8 months postoperatively (range, 24-115.2 months). Clinical outcome was obtained via Lysholm and International Knee Documentation Committee (IKDC) scores. Soccer players were matched 1:1 to non-soccer athletes for age, activity level, and graft type. Results: A total of 180 female ACLR patients with a mean ± SD age of 19.6 ± 6.9 years met the study inclusion and exclusion criteria (90 soccer players and 90 non-soccer players). Soccer players sustained more second ACL injuries, including both graft failures (11% vs 1%; P < .01) and contralateral ACL tears (17% vs 4%; P < .01), compared with non-soccer players. Of the 67 patients who returned to soccer after ACLR (mean age, 17.5 years; range, 13-27 years), significantly more had graft tears compared with those who did not return to soccer (15% vs 0%, respectively; P = .04); however, the difference in contralateral ACL tears (19% for returning players vs 9% for those who did not return; P = .34) was not significant. Relatively older age (odds ratio, 1.5 per year; P = .03) was a significant risk factor for ACL graft tear but not for contralateral ACL injury. Both groups had similar mean Lysholm (96 vs 95) and IKDC scores (95 vs 96) at final follow-up. Conclusion: Twenty-eight percent of all female soccer players and 34% of those players who returned to soccer had a second ACL tear. Soccer players had an increased rate of both graft tear and contralateral ACL injury compared with similar non-soccer athletes. Older age and return to soccer were significant risk factors for graft rupture.

Anterior Cruciate Ligament Reconstruction of the Knee Using Double Bundle Hamstring Autograft - Is the Remnant Preservation Technique Superior to the Standard Procedure in Terms of Long-Term Graft Failure Rate, the Need for Revision Operation, and Associated Clinical Dysfunction?

Background:Anterior cruciate remnant preservation may be beneficial in Anterior Cruciate Ligament Reconstruction (ACLR). Gohil, Annear & Breidahl (Sept, 2007) used a grade 1 randomised controlled trial to compare the two methods and at short term follow-up, the minimal debridement technique demonstrated earlier revascularisation within the ACL graft at 2 months, and suggested improved strength at 6 months based on radiological imaging. Unfortunately, this did not translate through to clinical benefits in the early 12 month post operative period. Zhang, L et al. (May, 2013) and Naylor, AJ et al. (2013) reiterated that remnant preservation may improve graft revascularization and knee proprioception. Takazawa Y et al. (Sept, 2013) demonstrated that minimal debridement may facilitate recovery of function and decreased graft rupture at two years post primary reconstruction. However, studies have yet to show consistent significant clinical advantages and follow-up has only been analysed over 1-2 years.Purpose:This current study reported results over a long-term follow-up of 10 years post operation for the same participants from the Gohil, Annear & Breidahl (2007) study.Study Design:The review was based on level 1 randomised controlled trial chart review.Methods:All 49 participants (25 standard – group 1, and 24 remnant preserving group – group 2) from the previous study have been included for investigation. The chart review recorded demographic data, graft rupture, re-operation rates, and associated clinical failures of the ACLR. The review presents comparative data between the two groups.Results:At 10 year follow-up, the remnant retention ACLR group only had better outcomes for ipsilateral graft rupture (2 patients versus 3 patients). Standard ACLR group had improved outcomes for contralateral graft rupture (2 versus 3), ipsilateral other knee post operative surgery (5 versus 10), ipsilateral knee post operative complaints (7 versus 12), and other non-knee post operative issues (3 versus 4). Non of the differences were statistically significant.Conclusion:Overall our results suggested no statistically significant difference between the remnant retaining and standard technique for ACLR in these 49 subjects using chart review endpoints of graft revision and knee reoperation rates. The review is limited by a small study group and a chart only review. A larger study group with long term clinical outcome measures may offer more definitive conclusions as to the advantages of remnant sparing ACLR. In this 10 year follow-up post ACL reconstruction there has been no distinct advantage identified for either procedure.

Return to Sport: Does Excellent 6-Month Strength and Function following ACL Reconstruction Predict Mid-Term Outcomes?

We sought to determine if patients with excellent functional and isokinetic performance at six months had 1) higher risk of subsequent ACL tears with earlier RTS, 2) superior knee function, and 3) increased activity levels at mid-term follow-up compared to those with delayed clearance for RTS. We identified 223 patients who underwent primary ACL reconstruction by a single surgeon and had functional and isokinetic testing performed six months postoperatively. An ‘excellent’ outcome was defined as having a satisfactory result in 6 of 7 isokinetic-strength and functional-testing categories. A satisfactory result was defined as minimum 85% performance in isokinetic strength and 90% performance in functional testing compared to the contralateral knee. Of the 223 patients, 52 (23.3%) met criteria for the early RTS group, leaving 171 (76.7%) comprising the delayed RTS group. Rate of ACL-graft tear (ipsilateral) and native-ACL tear (contralateral) were compared between the groups. Additionally, minimum two-year IKDC and Tegner scores were compared. Ten (4.5%) patients had an ipsilateral graft rupture, and 17 (7.6%) had a contralateral ACL tear after mean follow-up of 3.7 years (range 2-10). The graft rupture rate was similar in the early RTS group (3.8%, n=2) compared to the delayed RTS group (4.7%, n=8; p=0.30). However, there was a higher rate of contralateral ACL tear in the early RTS group (15.4%, n=8) compared to the delayed RTS group (5.3%, n=9; p=0.003). The early RTS group had superior IKDC scores (94.3 + 6.4 vs 90.9 + 9.7; p=0.04) and Tegner scores (6.6 + 1.8 vs 5.7 + 1.6; p=0.01). Patients with an excellent performance on their isokinetic-strength and functional-testing at six months after ACL reconstruction have superior knee function and higher activity levels at mid-term follow-up. However, these patients appear to be at greater risk of contralateral ACL injury, possibly related to their increased activity level.

Risk factors for ipsilateral graft rupture or contralateral anterior cruciate ligament tear after anatomic double-bundle reconstruction

PurposeThe purpose of this study was to clarify the risk factors for graft rupture or contralateral anterior cruciate ligament (ACL) tear after anatomic ACL reconstruction. MethodsOne hundred and eighty one patients with unilateral ACL injury underwent the anatomic double-bundle ACL reconstruction using autogenous semitendinosus tendon grafts. Of these, 149 patients were directly followed-up for more than 5 years (60–108 months) after the primary operation. For those with graft rupture or contralateral ACL tear, timing at re-injury and cause of re-injury were recorded. Demographic factors such as height, body weight, sex, age at operation and sports activity level, as well as the surgical factors such as graft diameter and associated meniscal injury were noted. ResultsEighteen patients (12.1%) sustained the graft rupture or the contralateral ACL injury in obvious accidents. Of them, ACL graft rupture occurred in seven patients (4.7%), whereas contralateral ACL injury occurred in 11 patients (7.4%). There was a high correlation between graft rupture and age (r = −0.962, p < 0.001) and activity level (r = 0.995, p < 0.001), whereas the other factors had no correlation. Age and activity level also had a high correlation with contralateral ACL tear (p < 0.001). ConclusionBoth youth and high-level sports activity were potential risk factors for ACL graft rupture or contralateral ACL tear, whereas the other demographic and surgical factors had no correlation to graft or ACL tear. Level of EvidenceLevel IV, case series.