ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022
A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it, 52 citations in OpenAlex.
- Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI) Scores over Time After Anterior Cruciate Ligament Reconstruction: A Systematic Review with Meta-analysis.Sports medicine - open · 2024Pooled it
- A simple planning tool for tibial slope osteotomy-Osteotomy depth is a precise parameter to determine wedge height.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- What does a failure in anterior cruciate ligament reconstruction really mean? An integrative view.Knee surgery & related research · 2026Review
- Posterior tibial slope increases over time in patients undergoing revision ACL reconstruction: A long-term radiographic follow-up study.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2026Article
- A higher posterior tibial slope and tunnel malposition do not predispose to non-traumatic anterior cruciate ligament failure.Journal of experimental orthopaedics · 2026Article
- Body Mass Index and the Risk of Repeat Revision Anterior Cruciate Ligament Reconstruction Failure.Orthopaedic journal of sports medicine · 2026Article
- Failed anterior cruciate ligament reconstructions have both increased posterior tibial slope and increased posterior tibial plateau offset.Journal of experimental orthopaedics · 2026Article
- Radiographic medial posterior tibial slope ≥16° predicts multiple revisions after anterior cruciate ligament reconstruction.Journal of experimental orthopaedics · 2026Article
- High posterior tibial slope is associated with higher failure rates in nonoperative management of primary anterior cruciate ligament injury.Journal of experimental orthopaedics · 2025Article
- Posterior tibial slope has no impact on treatment outcome in anterior cruciate ligament revision patients.Journal of experimental orthopaedics · 2025Article
- Slope reducing high tibial osteotomy and revision anterior cruciate ligament reconstruction leads to satisfying clinical results and a low failure rate.Journal of experimental orthopaedics · 2025Article
- Medial Meniscal Posterior Root Tears Are Associated With Steeper Medial Posterior Tibial Slope and Varus Alignment.Arthroscopy, sports medicine, and rehabilitation · 2025Article
- Over-The-Top Technique for ACL Reconstruction: Advantages, Disadvantages, and Postoperative Complications.Orthopaedic surgery · 2025Review
- Considerations in revision of anterior cruciate ligament reconstruction in the high-level athlete.Annals of joint · 2025Review
- Lateral Extraarticular Tenodesis in Revision Anterior Cruciate Ligament Reconstruction: An Analysis of Clinical Outcomes and Failure Rates.Journal of clinical medicine · 2024Article
- Considerations for revision anterior cruciate ligament reconstruction: A review of the current literature.Journal of orthopaedics · 2024Review
- Proximal tibial anatomical axis and anterior tibial cortex-based measurements of posterior tibial slope on lateral radiographs differ least from actual posterior tibial slope-A biomechanical study.Journal of experimental orthopaedics · 2024Article
- Evaluation of Failed ACL Reconstruction: An Updated Review.Open access journal of sports medicine · 2024Review
- [Influence of the bony alignment on the ligaments of the knee joint].Unfallchirurgie (Heidelberg, Germany) · 2024Review
- The Posterior Tibial Slope Is Not Associated With Graft Failure and Functional Outcomes After Anatomic Primary Isolated Anterior Cruciate Ligament Reconstruction.The American journal of sports medicine · 2023Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo compare clinical outcomes, radiographic characteristics, and surgical factors between patients with single and multiple anterior cruciate ligament (ACL) graft failures. It was hypothesized that patients experiencing multiple ACL graft failures exhibit lower patient-reported outcome scores (PROs) and a higher (steeper) posterior tibial slope (PTS) than patients with single ACL graft failure.
methodsPatients undergoing revision ACL reconstruction with a minimum follow-up of 12 months were included in this retrospective cohort study. Based on the number of ACL graft failures, patients were assigned either to the group "single ACL graft failure "or" multiple ACL graft failures ". The PTS was measured on strict lateral radiographs. Validated PROs including the International Knee Documentation Committee (IKDC) subjective knee form, Knee Injury and Osteoarthritis Outcome Score, Lysholm Score, Tegner Activity Scale, ACL-Return to Sport after Injury Scale, and Visual Analogue Scale for pain were collected.
resultsOverall, 102 patients were included with 58 patients assigned to the single ACL graft failure group and 44 patients to the multiple ACL graft failures group. Quadriceps tendon autograft was used significantly more often (55% vs. 11%, p < 0.001) and allografts were used significantly less often (31% vs. 66%, p < 0.001) as the graft for first revision ACL reconstruction in patients with single versus multiple ACL graft failures. Patients with multiple ACL graft failures were associated with statistically significantly worse PROs (IKDC: 61.7 ± 19.3 vs. 77.4 ± 16.8, p < 0.05; Tegner Activity Scale: 4 (range, 0-7) vs. 6 (range 2-10), p < 0.05), higher PTS (12 ± 3° vs. 9 ± 3°, p < 0.001), and higher rates of subsequent surgery (73% vs. 14%, p < 0.001) and complications (45% vs. 17%, p < 0.05) than patients with single ACL graft failure.
conclusionCompared to single ACL graft failure in this study multiple ACL graft failures were associated with worse PROs, higher PTS, and allograft use. During the first revision ACL reconstruction, it is recommended to avoid the use of allografts and to consider slope-reducing osteotomies to avoid multiple ACL graft failures and improve PROs. LEVEL OF EVIDENCE: Level 3.
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