{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:51:53Z","timestamp":1792079513379,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"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":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to determine graft failure rates after primary anterior cruciate ligament reconstruction (ACLR) in professional soccer players and to evaluate factors associated with graft failure, including lateral extra\u2010articular augmentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective cohort study included 232 primary ACLRs in 215 professional soccer players: isolated ACLR (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931) and ACLR combined with a lateral extra\u2010articular procedure (LEAP) (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009201). The primary endpoint was graft failure, defined as symptomatic rupture confirmed clinically and by imaging or revision surgery. Time\u2010to\u2010event analyses accounted for variable follow\u2010up. Contralateral ACL injury was recorded descriptively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At a mean follow\u2010up of 100 months, 13 graft failures occurred (5.6%). Unadjusted failure rates were lower in ACLR\u2009+\u2009LEAP versus isolated ACLR (4.5% vs. 12.9%), but survival analysis showed no significant difference (hazard ratio [HR] 2.48; 95% confidence interval [CI] 0.49\u20139.87;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.246). Multivariable Cox regression identified no independent predictors of graft failure. Mean time to graft failure was longer in the ACLR\u2009+\u2009LEAP group than in the isolated ACLR group (54.8\u2009\u00b1\u200952.0 vs. 36.6\u2009\u00b1\u200938.2 months). Reoperations occurred in 32 knees (17.7%), with rates of 15.2% in the ACLR\u2009+\u2009LEAP group and 30.0% in the isolated ACLR group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0528). Increased preoperative laxity (\u22657\u2009mm; HR 2.72; 95% CI 1.23\u20136.17;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014) and bone\u2013patellar tendon\u2013bone graft use (HR 3.14; 95% CI 1.26\u20137.20;\n                      <jats:italic>p\u2009<\/jats:italic>\n                      =\u20090.037) were independent risk factors for reoperation. Contralateral ACL injury occurred in 27.1% of knees, more frequently in female athletes (48.7% vs. 22.8%). Among patients who experienced graft failure, 53.8% also had a contralateral ACL injury.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Primary ACL reconstruction in professional soccer players was associated with durable long\u2010term graft survival. Although ACLR combined with an LEAP was associated with fewer graft failures than isolated ACLR, an independent protective effect was not confirmed. The high rate of contralateral ACL injury highlights the multifactorial nature of reinjury risk in this elite population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70641","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:31:18Z","timestamp":1792078278000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low graft failure after primary anterior cruciate ligament reconstruction in professional soccer players: A retrospective cohort study of 232 knees from the SANTI Study Group"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0649-1055","authenticated-orcid":false,"given":"Fabio","family":"Santamaria","sequence":"first","affiliation":[{"name":"Ramsay Sant\u00e9, H\u00f4pital priv\u00e9 Jean Mermoz, Centre Orthop\u00e9dique Santy FIFA Medical Center of Excellence Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Mendes","family":"Santos","sequence":"additional","affiliation":[{"name":"Ramsay Sant\u00e9, H\u00f4pital priv\u00e9 Jean Mermoz, Centre Orthop\u00e9dique Santy FIFA Medical Center of Excellence Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7233-3821","authenticated-orcid":false,"given":"Merwane","family":"Ayata","sequence":"additional","affiliation":[{"name":"Ramsay Sant\u00e9, H\u00f4pital priv\u00e9 Jean Mermoz, Centre Orthop\u00e9dique Santy FIFA Medical Center of Excellence Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8076-7102","authenticated-orcid":false,"given":"Hussein","family":"Wehbe","sequence":"additional","affiliation":[{"name":"Ramsay Sant\u00e9, H\u00f4pital priv\u00e9 Jean Mermoz, Centre Orthop\u00e9dique Santy FIFA Medical Center of Excellence Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Sonnery\u2010Cottet","sequence":"additional","affiliation":[{"name":"Ramsay Sant\u00e9, H\u00f4pital priv\u00e9 Jean Mermoz, Centre Orthop\u00e9dique Santy FIFA Medical Center of Excellence Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao Pedro","family":"Campos","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery Department Hospital Pedro Hispano Matosinhos Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6083-3026","authenticated-orcid":false,"given":"Jacopo","family":"Corti","sequence":"additional","affiliation":[{"name":"Ramsay Sant\u00e9, H\u00f4pital priv\u00e9 Jean Mermoz, Centre Orthop\u00e9dique Santy FIFA Medical Center of Excellence Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1624-1824","authenticated-orcid":false,"given":"Thais Dutra","family":"Vieira","sequence":"additional","affiliation":[{"name":"Ramsay Sant\u00e9, H\u00f4pital priv\u00e9 Jean Mermoz, Centre Orthop\u00e9dique Santy FIFA Medical Center of Excellence Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6837-0425","authenticated-orcid":false,"given":"Bertrand","family":"Sonnery\u2010Cottet","sequence":"additional","affiliation":[{"name":"Ramsay Sant\u00e9, H\u00f4pital priv\u00e9 Jean Mermoz, Centre Orthop\u00e9dique Santy FIFA Medical Center of Excellence Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1672120"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1736514"},{"issue":"7","key":"e_1_2_13_4_1","doi-asserted-by":"crossref","DOI":"10.1177\/2325967121S00236","article-title":"Lateral extra\u2010articular tenodesis reduces the rate of revision anterior cruciate ligament reconstruction in elite athletes","volume":"9","author":"Balendra G","year":"2021","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231157377"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12434"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221128828"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231198494"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465251376655"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241285887"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2020-103555"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465211061150"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519896333"},{"issue":"12","key":"e_1_2_13_14_1","doi-asserted-by":"crossref","DOI":"10.1177\/23259671251391362","article-title":"Return to sport and risk of second anterior cruciate ligament (ACL) injury in elite male footballers: 10\u2010year experience from a single center","volume":"13","author":"Grassi A","year":"2025","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221085027"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-016-3261-9"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jisako.2022.12.001"},{"issue":"12","key":"e_1_2_13_18_1","doi-asserted-by":"crossref","DOI":"10.1177\/23259671251397660","article-title":"Reducing graft failure and reoperation after anterior cruciate ligament reconstruction in professional athletes using a systematic surgical approach: an analysis of 342 patients with a mean follow\u2010up of 100 months from the SANTI Study Group","volume":"13","author":"Hopper GP","year":"2025","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221119186"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516681555"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096836"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516656835"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465221118377"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514530088"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0b013e318246ef9e"},{"issue":"9","key":"e_1_2_13_26_1","doi-asserted-by":"crossref","DOI":"10.1177\/2325967125S00059","article-title":"Paper 02: ACL + ALL outperforms isolated ACL reconstruction: 5\u2010year outcomes from a SANTI Study Group randomized clinical trial","volume":"13","author":"Saithna A","year":"2025","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465261448200"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465231168899"},{"issue":"9","key":"e_1_2_13_29_1","doi-asserted-by":"crossref","DOI":"10.1177\/2325967125S00060","article-title":"Paper 03: lateral extra\u2010articular tenodesis in ACL reconstruction is associated with reduced failure rate and lower residual rotational instability in female soccer athletes","volume":"13","author":"Tummala S","year":"2025","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/03635465211062609"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2005.021055"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516651845"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515621554"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.70641","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ksa.70641","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ksa.70641","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:31:20Z","timestamp":1792078280000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1002\/ksa.70641"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":32,"alternative-id":["10.1002\/ksa.70641"],"URL":"https:\/\/doi.org\/10.1002\/ksa.70641","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"2026-03-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ksa.70641"}}