A Systematic Review of Factors Associated with both Bilateral and Recurrent Anterior Cruciate Ligament Disruption

Background: Numerous studies have reported factors associated with recurrent or subsequent contralateral anterior cruciate ligament disruption, but a comprehensive review of the literature has not been performed.

Purpose: This study attempts to systematically review the literature and provide an overview of the currently reported risk factors for recurrent and subsequent contralateral ACL reconstructions in order to allow for more efficient identification and intervention of high-risk patients.

Study Design: Systematic Review.

Methods: The Pubmed and Embase databases were searched using a combination of keywords such as “ACL reconstruction” and “bilateral or recurrent” and “risk factors” and medical subject headings. All studies were screened by two independent reviewers, and articles that met inclusion criteria (non-contact ACL injury, study analyzed risk factors for contralateral ACL injury or graft rupture) were downloaded and read.

Results: The initial search yielded 129 articles, of which 36 met inclusion criteria. After duplicates were removed, 23 articles remained. The reference lists of included articles were cross-referenced, and an additional 2 articles were included.

Conclusion: Graft harvest site, allograft usage, return to sport, younger age, a positive family history, increased posterior tibial slope, and the number of previous ACL reconstructions are well-reported risk factors for second ACL injury. Recent studies suggest a patients who have negative psychological states in the perioperative periods have worse long-term functional outcomes.