{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T22:57:52Z","timestamp":1788130672234,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"Abstract<\/jats:title>\n \n Purpose<\/jats:title>\n To identify factors associated with knee extension loss prior to anterior cruciate ligament (ACL) reconstruction (ACLR).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients without concomitant ligament injuries who underwent primary ACLR at the Capio Artro Clinic, Stockholm, Sweden, between 1 January 2002 and 31 December 2023, were eligible for inclusion. The outcome of the study was the presence of preoperative extension loss, defined as a deficit of \u22655 degrees prior to ACLR. Univariable and multivariable logistic regression analyses were conducted to assess associations between the study outcome and the following variables: age at surgery, sex, time from injury to surgery, preinjury Tegner activity level, cartilage injury, medial meniscus or lateral meniscus injury, and physiologic contralateral knee extension deficit (\u22655 degrees).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 10,692 patients were included. The overall incidence of extension loss prior to ACLR was 6.3% (677\/10,692). Multivariable logistic regression analysis showed that early surgery (\u22643 months) (odds ratio [OR]: 2.94; 95% confidence interval [CI]: 2.43\u20133.57;\n p<\/jats:italic>\n \u2009<\u20090.001), medial meniscus injury (OR: 1.30; 95% CI: 1.07\u20131.57;\n p<\/jats:italic>\n \u2009=\u20090.01), lateral meniscus injury (OR: 1.23; 95% CI: 1.01\u20131.48;\n p<\/jats:italic>\n \u2009=\u20090.04) and physiologic contralateral knee extension deficit (OR: 34.38; 95% CI: 25.36\u201346.61;\n p<\/jats:italic>\n \u2009<\u20090.001) were associated with increased odds of extension loss prior to ACLR. No associations were found between preoperative extension loss and age at surgery, sex, preinjury Tegner activity level, or the presence of a cartilage injury.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Preoperative extension loss was observed in 6.3% of the patients undergoing ACLR. Early surgery (\u22643 months), medial or lateral meniscal injury, and physiologic contralateral knee extension deficit were associated with increased odds of preoperative extension loss. Awareness of these factors may assist clinicians identify patients at risk for extension loss and optimise preoperative management strategies prior to ACLR.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level III.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ksa.70173","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T09:52:01Z","timestamp":1762249921000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Early surgery, meniscal injury and physiologic contralateral knee extension deficit are associated with extension loss prior to anterior cruciate ligament reconstruction"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3286-4060","authenticated-orcid":false,"given":"Riccardo","family":"Cristiani","sequence":"first","affiliation":[{"name":"Department of Molecular Medicine and Surgery Section of Sports Medicine, Karolinska Institutet Stockholm Sweden"},{"name":"Stockholm Sports Trauma Research Center (SSTRC), FIFA Medical Centre of Excellence, Sophiahemmet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Sandstr\u00f6m","sequence":"additional","affiliation":[{"name":"University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoffer","family":"von Essen","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery Section of Sports Medicine, Karolinska Institutet Stockholm Sweden"},{"name":"Stockholm Sports Trauma Research Center (SSTRC), FIFA Medical Centre of Excellence, Sophiahemmet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Hamrin","family":"Senorski","sequence":"additional","affiliation":[{"name":"Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Samuelsson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"St\u00e5lman","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery Section of Sports Medicine, Karolinska Institutet Stockholm Sweden"},{"name":"Stockholm Sports Trauma Research Center (SSTRC), FIFA Medical Centre of Excellence, Sophiahemmet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Mikkelsen","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery Section of Sports Medicine, Karolinska Institutet Stockholm Sweden"},{"name":"Stockholm Sports Trauma Research Center (SSTRC), FIFA Medical Centre of Excellence, Sophiahemmet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"issue":"3","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.3899\/jrheum.2023-0743","article-title":"Association of knee osteoarthritis and flexion contracture with localized tibial articular cartilage loss: data from the osteoarthritis initiative","volume":"51","author":"Campbell TM","year":"2024","journal-title":"J Rheumatol"},{"issue":"5","key":"e_1_2_12_3_1","first-page":"993","article-title":"Flexion contracture is associated with knee joint degeneration on magnetic resonance imaging: data from the Osteoarthritis Initiative","volume":"40","author":"Campbell TM","year":"2022","journal-title":"Clin Exp Rheumatol"},{"issue":"1","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1177\/036354659502300115","article-title":"Prevention of arthrofibrosis after 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