Journal article
Having a Revision ACL Reconstruction Is Worse Than Tearing the Contralateral ACL and Undergoing Reconstruction: A MOON Cohort Study
The American journal of sports medicine
02/16/2026
DOI: 10.1177/03635465261416923
PMID: 41696862
Abstract
Anterior cruciate ligament (ACL) graft tears and contralateral ACL tears are both relatively common after primary ACL reconstruction (ACLR). There is little prior work comparing the outcomes of reconstruction after these injuries.
The authors hypothesize that patient-reported outcome measures (PROMs) and activity level are lower after revision ACLR than after primary contralateral ACLR.
Cohort study; Level of evidence, 3.
From a cohort of 2333 patients who underwent primary unilateral ACLR, 267 were identified who underwent subsequent revision ACLR or primary contralateral ACLR within 5 years of primary ACLR. After exclusion of 11 patients who had both injuries, 256 were eligible for the study, including 124 who underwent revision ACLR and 132 who underwent primary contralateral ACLR. Patients were contacted for follow-up at 6 years after the primary ACLR, and PROMs were collected, including subjective International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score for pain (KOOS-Pain) and knee-related quality of life (KOOS-QOL), and Marx activity level. Patient demographics, surgical factors, and PROMs were compared between groups. Beta regression models with identity link were used to determine whether side of subsequent surgery (revision vs primary contralateral ACLR) was a significant predictor of outcome.
Of 256 patients, 223 (87%) were contacted and completed PROMs at 6 years after the primary ACLR. At baseline, there were no significant differences between groups except that the subsequent revision group had a lower incidence of partial lateral meniscectomy and a higher incidence of lateral meniscal repair and was more likely to have received allograft for the primary ACLR than the subsequent contralateral reconstruction group. The median time from primary ACLR to second ACL surgery was lower in the revision group (1.3 years) than the contralateral group (2.0 years;
< .001). When controlling for demographics, surgical factors, and baseline PROMS, the revision ACL group demonstrated a 7.8-point lower International Knee Documentation Committee score (
< .001), a 3.2-point lower KOOS-Pain score (
= .012), a 10.4-point lower KOOS-QOL score (
< .001), and 2.0-point lower Marx score (
= .002) than the contralateral ACLR group.
Patients who undergo revision ACLR within 5 years of primary ACLR demonstrate poorer PROMs and lower activity levels than those who undergo primary contralateral ACLR during this period. These 2 groups of patients should not be pooled to study outcomes of ACLR.
Details
- Title: Subtitle
- Having a Revision ACL Reconstruction Is Worse Than Tearing the Contralateral ACL and Undergoing Reconstruction: A MOON Cohort Study
- Creators
- Robert A Magnussen - The Ohio State UniversityAnnunziata Ned Amendola - Duke UniversityJack T Andrish - Cleveland ClinicRobert H Brophy - Washington University in St. LouisCharles L Cox - Vanderbilt UniversityDavid C Flanigan - The Ohio State UniversityLaura J Huston - Vanderbilt UniversityYuxuan Jin - Cleveland ClinicMorgan H Jones - Brigham and Women's HospitalChristopher C Kaeding - The Ohio State UniversityRobert G Marx - Hospital for Special SurgeryMatthew J Matava - Washington University in St. LouisEric C McCarty - University of Colorado BoulderRichard D Parker - Cleveland ClinicEmily K Reinke - Duke UniversityArmando Vidal - Steadman ClinicMichelle L Wolcott - University of Colorado BoulderBrian R Wolf - University of IowaRick W Wright - Vanderbilt UniversityKurt P Spindler - Cleveland Clinic
- Resource Type
- Journal article
- Publication Details
- The American journal of sports medicine
- DOI
- 10.1177/03635465261416923
- PMID
- 41696862
- NLM abbreviation
- Am J Sports Med
- ISSN
- 0363-5465
- eISSN
- 1552-3365
- Publisher
- Sage
- Grant note
- National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases: AR075422, R01 AR074131, AR053684 MoximedVericelSmith NephewHyalex Orthopaedics and Just Cause ApparelBreg IncArthrex Inc
One or more of the authors has declared the following potential conflict of interest or source of funding: K.P.S. has received consulting fees from Novo Pedics, National Football League, Wake Forrest, and PRO-T; and is the Chair of the Publishing Advisory Board for AOSSM. Cleveland Clinic licensed Outcome Measurement and Evaluation (OME) technology used in this study to Oberd; K.P.S. is an inventor of the technology, and Cleveland Clinic is entitled to royalties from Oberd. K.P.S. has received grants from National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR075422, R01 AR074131, and AR053684). R.A.M. has received research funding from Moximed, Vericel, and Smith & Nephew. R.W.W. has received financial support from Hyalex Orthopaedics and Just Cause Apparel and stock and royalties from Responsive Arthroscopy and is on the board of relationship for AOSSM. M.J.M. has received consulting fees from Arthrex Inc; an unrestricted education grant for fellowship support from Breg Inc, Arthrex Inc, and Smith & Nephew Inc; and speaker fees from Elite Orthopedics. M.J.M. is also a board member for AOSSM. D.C.F. has received consulting fees from Smith & Nephew, Vericel, Moximed, J7J Sports, Hyalex, Anika, Arcuro, Nanochon, Conmed, and Medipost. M.H.J. has received consulting income from Grunenthal and Regeneron for scientific advisory and from the Journal of Bone and Joint Surgery for curriculum development; is an unpaid member of the editorial board of OJSM; and has received grant support to his institution from Pacira, Arthritis Foundation, and the National Institutes of Health. B.R.W. has received royalties and consulting fees from ConMed and is a member of the board of directors for AOSSM, American Board of Orthopaedic Surgery, and Mid-America Orthopaedic Association. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
- Language
- English
- Electronic publication date
- 02/16/2026
- Academic Unit
- Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science
- Record Identifier
- 9985139488102771
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