Evidence map›Paper›PMID 26772611›Full record

SynthesisThe American journal of sports medicine2016

Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Amelia J Wiggins, Ravi K Grandhi, Daniel K Schneider, Denver Stanfield, Kate E Webster, Gregory D Myer

2 registry-linked trialsOpen access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The American journal of sports medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 599 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
599citing papers in PubMed, 8 pooled it
84.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04178538 naunknown statusnot on this mapstarted 2019, after this paper: background citation

The Effect of Bone Marrow Aspirate, Demineralized Bone Matrix, and InternalBrace™ on the Outcomes of Anterior Cruciate Ligament Reconstruction in Young Adults; Failure Rates and Return to Play

TypeinterventionalSponsorMarshall UniversityRan2019 to 2023Enrolled60ConditionsACL Tear, ACL Injury, Arthroscopy, Anterior Cruciate Ligament TearArmsACL reconstruction with bone marrow, demineralized bone marix, and internal brace augmentation, Standard ACL reconstruction with all inside technique
NCT07476430 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Readiness Outcomes Affecting Return to Sport 3.0

TypeinterventionalSponsorBoston Children's HospitalRan2026 to 2028Enrolled130ConditionsACL ReconstructionArmsMental Skills Training (MST)
3 · Its place in the literature

Who cites it

599 citing papers in PubMed, 8 syntheses or guidelines pooled it, 1,259 citations in OpenAlex.

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  12. Efficacy of platelet-rich plasma in grade 2 hamstring muscle injuries: results from a randomized controlled trial.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025
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539 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 5 institutions in 2 countries.

Amelia J WigginsDepartment of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
Ravi K GrandhiDepartment of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Daniel K SchneiderCollege of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Denver StanfieldDivision of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Kate E WebsterWellington Orthopaedic Surgery and Sports Medicine, Mercy Health, Cincinnati, Ohio, USA.
Gregory D MyerSchool of Allied Health, La Trobe University, Melbourne, Australia The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA greg.myer@cchmc.org.
University of Cincinnati · USCincinnati Children's Hospital Medical Center · USMercy Health · USThe Micheli Center for Sports Injury Prevention · USUniversity of Cincinnati Medical Center · US

Funding

Identification of Patellofemoral Pain Risk Factors Developed During MaturationR21AR065068 · NIAMS · CINCINNATI CHILDRENS HOSP MED CTR · PI MYER, GREGORY DONALD · 2015 to 2016
$378k
NIAMS NIH HHS R21 AR065068
6 · The paper itself

Abstract

backgroundInjury to the ipsilateral graft used for reconstruction of the anterior cruciate ligament (ACL) or a new injury to the contralateral ACL are disastrous outcomes after successful ACL reconstruction (ACLR), rehabilitation, and return to activity. Studies reporting ACL reinjury rates in younger active populations are emerging in the literature, but these data have not yet been comprehensively synthesized. PURPOSE: To provide a current review of the literature to evaluate age and activity level as the primary risk factors in reinjury after ACLR. STUDY

designSystematic review and meta-analysis.

methodsA systematic review of the literature was conducted via searches in PubMed (1966 to July 2015) and EBSCO host (CINAHL, Medline, SPORTDiscus [1987 to July 2015]). After the search and consultation with experts and rating of study quality, 19 articles met inclusion for review and aggregation. Population demographic data and total reinjury (ipsilateral and contralateral) rate data were recorded from each individual study and combined using random-effects meta-analyses. Separate meta-analyses were conducted for the total population data as well as the following subsets: young age, return to sport, and young age + return to sport.

resultsOverall, the total second ACL reinjury rate was 15%, with an ipsilateral reinjury rate of 7% and contralateral injury rate of 8%. The secondary ACL injury rate (ipsilateral + contralateral) for patients younger than 25 years was 21%. The secondary ACL injury rate for athletes who return to a sport was also 20%. Combining these risk factors, athletes younger than 25 years who return to sport have a secondary ACL injury rate of 23%.

conclusionThis systematic review and meta-analysis demonstrates that younger age and a return to high level of activity are salient factors associated with secondary ACL injury. These combined data indicate that nearly 1 in 4 young athletic patients who sustain an ACL injury and return to high-risk sport will go on to sustain another ACL injury at some point in their career, and they will likely sustain it early in the return-to-play period. The high rate of secondary injury in young athletes who return to sport after ACLR equates to a 30 to 40 times greater risk of an ACL injury compared with uninjured adolescents. These data indicate that activity modification, improved rehabilitation and return-to-play guidelines, and the use of integrative neuromuscular training may help athletes more safely reintegrate into sport and reduce second injury in this at-risk population.

Indexed as

Anterior Cruciate Ligament ReconstructionAdolescentAge FactorsAnterior Cruciate Ligament InjuriesAthletesAthletic InjuriesFemaleHumansMaleRecurrenceReturn to SportRisk FactorsYoung AdultACL injuryACL revisionknee injuryknee injury prevention

Identifiers

PMID26772611
PMCPMC5501245
OpenAlexW2278417395

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.