{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T12:13:07Z","timestamp":1779451987180,"version":"3.53.1"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"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 The purpose of this study was to assess the association between surgical\u2010related variables, revision\u2010free survival and knee injury and osteoarthritis outcome score (KOOS) following multiple revision anterior cruciate ligament reconstruction (mrACLR) using data from a national knee ligament registry.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A registry study was conducted using data from the Swedish knee ligament registry. All mrACLRs (\n n<\/jats:italic>\n \u2009=\u20094012, two or more revisions) performed in patients over 18 years at the time of the index mrACLR surgery were considered for inclusion. The primary endpoint was time of graft failure (requiring subsequent revision). The secondary endpoints were patient\u2010reported outcome failures at 1 and 2 years, defined as: (1) failure to achieve the patient acceptable symptom state (PASS) and independently (2) the minimal important change (MIC) on KOOS. Cox proportional hazards models and logistic regression analyses were used to determine the risk of treatment choices for graft failure with respect to the assessed variables.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The final study cohort consisted of 918 patients who underwent mrACLR. The mean age was 26.4\u2009\u00b1\u20098.5 years, 52.5% were male, and bone\u2010patellar tendon\u2010bone autograft was the most commonly used graft type (61.0%). Allograft use was associated with a threefold increase in likelihood of undergoing re\u2010revision compared to bone\u2010patellar tendon\u2010bone autograft (hazard ratio [HR] 3.06; 95% confidence interval [CI]: 1.24\u20137.60;\n p<\/jats:italic>\n \u2009=\u20090.016). For femoral fixation, an adjustable suspensory device was associated with a lower likelihood of re\u2010revision compared to fixed suspensory fixation (HR 0.30; 95% CI 0.10\u20130.92;\n p<\/jats:italic>\n \u2009=\u20090.035). Femoral interference screw fixation was associated with nearly double the odds of failing to achieve the PASS on any one or more of the five KOOS subscales at 1\u2010year follow\u2010up (OR 1.94; 95% CI 1.20\u20133.13;\n p<\/jats:italic>\n \u2009=\u20090.0069). Patients who underwent a concomitant cartilage procedure were more likely to achieve the MIC at 1\u2010year (OR 0.42; 95% CI 0.22\u20130.80;\n p<\/jats:italic>\n \u2009=\u20090.0084).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Based on unadjusted registry analyses, allograft use was associated with an increased risk of re\u2010revision compared to bone\u2010patellar tendon\u2010bone autograft, while adjustable suspensory femoral fixation was associated with a lower re\u2010revision hazard than fixed suspensory fixation. These findings represent unadjusted associations and should be interpreted in the context of the study's observational design.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level III, retrospective cohort study.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ksa.70433","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T11:56:59Z","timestamp":1779451019000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Allograft use and fixed suspensory fixation increase revision risk in multiple revision anterior cruciate ligament reconstruction: A Swedish knee ligament registry study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9721-685X","authenticated-orcid":false,"given":"Felix Conrad","family":"Oettl","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Balgrist University Hospital University of Z\u00fcrich Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Hamrin","family":"Senorski","sequence":"additional","affiliation":[{"name":"Sahlgrenska Sports Medicine Center G\u00f6teborg Sweden"},{"name":"Department of Health and Rehabilitation, Institute of Neuroscience and Physiology University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Pruneski","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tripler Army Medical Center Honolulu Hawaii USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e1lint","family":"Zsidai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Sk\u00e5ne University Hospital Malm\u00f6 Lund Sweden"},{"name":"Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armin","family":"Runer","sequence":"additional","affiliation":[{"name":"Department of Sports Orthopaedics Klinikum rechts der Isar, Technical University of Munich Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Musahl","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Samuelsson","sequence":"additional","affiliation":[{"name":"Sahlgrenska Sports Medicine Center G\u00f6teborg Sweden"},{"name":"Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Cristiani","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 Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","DOI":"10.1177\/2325967120930296","article-title":"Perioperative and postoperative factors influence quadriceps atrophy and strength after ACL reconstruction: a systematic review","volume":"8","author":"Baron JE","year":"2020","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.2517-6161.1972.tb00899.x","article-title":"Regression models and life\u2010tables","volume":"34","author":"Cox DR","year":"1972","journal-title":"J R Stat Soc Ser B Stat 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reconstruction","volume":"44","author":"Muller B","year":"2016","journal-title":"Am J Sports Med"},{"key":"e_1_2_13_16_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.2519\/jospt.1998.28.2.88","article-title":"Knee injury and osteoarthritis outcome score (KOOS)\u2010\u2010development of a self\u2010administered outcome measure","volume":"28","author":"Roos EM","year":"1998","journal-title":"J Orthop Sports Phys Ther"},{"key":"e_1_2_13_17_1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s40634-023-00601-3","article-title":"Current trends in graft choice for primary anterior cruciate ligament reconstruction \u2010 part II: in\u2010vivo kinematics, patient reported outcomes, re\u2010rupture rates, strength recovery, return to sports and complications","volume":"10","author":"Runer A","year":"2023","journal-title":"J Exp Orthop"},{"key":"e_1_2_13_18_1","first-page":"60","article-title":"Quadriceps tendon autograft for primary anterior cruciate ligament reconstruction show comparable clinical, functional, and patient\u2010reported outcome measures, but lower donor\u2010site morbidity compared with hamstring tendon autograft: a matched\u2010pairs study with a mean follow\u2010up of 6.5 years","volume":"8","author":"Runer A","year":"2023","journal-title":"J ISAKOS Jt Disord Orthop Sports Med"},{"key":"e_1_2_13_19_1","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1016\/j.arthro.2015.11.026","article-title":"Suspensory versus interference screw fixation for arthroscopic anterior cruciate ligament reconstruction in a translational large\u2010animal model","volume":"32","author":"Smith PA","year":"2016","journal-title":"Arthroscopy"},{"key":"e_1_2_13_20_1","doi-asserted-by":"crossref","DOI":"10.1177\/2325967118813917","article-title":"Relationship between time to ACL reconstruction and presence of adverse changes in the knee at the time of reconstruction","volume":"6","author":"Sommerfeldt 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