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The primary outcome was the occurrence of revision ACLR within 2 years of primary ACLR. Univariate and multivariate logistic regression analyses were used to evaluate preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre\u2010injury Tegner activity level], intraoperative [graft type, graft diameter, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [side\u2010to\u2010side (STS) anterior laxity, limb symmetry index (LSI) for quadriceps and hamstring strength and single\u2010leg\u2010hop test performance at 6\u00a0months] risk factors for revision ACLR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 6,510 primary ACLRs were included. The overall incidence of revision ACLR within 2 years was 2.5%. Univariate analysis showed that age\u2009&lt;\u200925 years, BMI\u2009&lt;\u200925\u00a0kg\/m<jats:sup>2<\/jats:sup>, time from injury to surgery\u2009&lt;\u200912\u00a0months, pre\u2010injury Tegner activity level\u2009\u2265\u20096, LM repair, STS laxity\u2009&gt;\u20095\u00a0mm, quadriceps strength and single\u2010leg\u2010hop test LSI of\u2009\u2265\u200990% increased the odds; whereas, MM resection and the presence of a cartilage injury reduced the odds of revision ACLR. Multivariate analysis revealed that revision ACLR was significantly related only to age\u2009&lt;\u200925 years (OR 6.25; 95% CI 3.57\u201311.11; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), time from injury to surgery\u2009&lt;\u200912\u00a0months (OR 2.27; 95% CI 1.25\u20134.17; <jats:italic>P<\/jats:italic>\u2009=\u20090.007) and quadriceps strength LSI of\u2009\u2265\u200990% (OR 1.70; 95% CI 1.16\u20132.49; <jats:italic>P<\/jats:italic>\u2009=\u20090.006).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Age\u2009&lt;\u200925 years, time from injury to surgery\u2009&lt;\u200912\u00a0months and 6\u2010month quadriceps strength LSI of\u2009\u2265\u200990% increased the odds of revision ACLR within 2 years of primary ACLR. Understanding the risk factors for revision ACLR has important implications when it comes to the appropriate counseling for primary ACLR. In this study, a large spectrum of potential risk factors for revision ACLR was analyzed in a large cohort. Advising patients regarding the results of an ACLR should also include potential risk factors for revision surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06517-8","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T03:02:53Z","timestamp":1614826973000},"page":"4154-4162","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Age, time from injury to surgery and quadriceps strength affect the risk of revision surgery after primary ACL reconstruction"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3286-4060","authenticated-orcid":false,"given":"Riccardo","family":"Cristiani","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Molecular Medicine and Surgery Stockholm Sports Trauma Research Center, Karolinska Institutet Stockholm Sweden"},{"name":"<!--<label>2<\/label>--> Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital Valhallav\u00e4gen 91 11486 Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Forssblad","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Molecular Medicine and Surgery Stockholm Sports Trauma Research Center, Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar","family":"Edman","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Molecular Medicine and Surgery Stockholm Sports Trauma Research Center, Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Eriksson","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Department of Orthopaedics Stockholm South Hospital, Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"St\u00e5lman","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Molecular Medicine and Surgery Stockholm Sports Trauma Research Center, Karolinska Institutet Stockholm Sweden"},{"name":"<!--<label>2<\/label>--> Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital Valhallav\u00e4gen 91 11486 Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514531396"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514552788"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2013.07.270"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010018\u20105059\u20103"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.03.038"},{"key":"e_1_2_8_7_2","unstructured":"CristianiR JanarvPM Engstr\u00f6mB EdmanG ForssbladM St\u00e5lmanA(2020)Delayed anterior cruciate ligament reconstruction increases the risk of abnormal pre\u2010reconstruction laxity cartilage and medial meniscus injuries.Arthroscopy.https:\/\/doi.org\/10.1016\/j.arthro.2020.11.030.(Epub ahead of print. 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