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The outcome of the study was the occurrence of contralateral ACLR within 5 years of primary ACLR. Univariable and multivariable logistic regression analyses were employed to identify preoperative [age, gender, body mass index (BMI), time from injury to surgery, pre\u2010injury Tegner activity level], intraoperative [graft type, medial meniscus (MM) and lateral meniscus (LM) resection or repair, cartilage injury] and postoperative [limb symmetry index (LSI) for quadriceps and hamstring strength and single\u2010leg\u2010hop test performance at 6\u00a0months] risk factors for contralateral ACLR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 5393 patients who underwent primary ACLR were included. The incidence of contralateral ACLR within 5 years was 4.7%. Univariable analysis revealed that age\u2009\u2265\u200925 years, BMI\u2009\u2265\u200925\u00a0kg\/m<jats:sup>2<\/jats:sup>, time from injury to surgery\u2009\u2265\u200912\u00a0months and the presence of a cartilage injury reduced the odds, whereas female gender, pre\u2010injury Tegner activity level\u2009\u2265\u20096, quadriceps and hamstring strength and a single\u2010leg\u2010hop test LSI of\u2009\u2265\u200990% increased the odds of contralateral ACLR. Multivariable analysis showed that the risk of contralateral ACLR was significantly affected only from age\u2009\u2265\u200925 years (OR 0.40; 95% CI 0.28\u20130.58; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), time from injury to surgery\u2009\u2265\u200912\u00a0months (OR 0.48; 95% CI 0.30\u20130.75; <jats:italic>P<\/jats:italic>\u2009=\u20090.001) and a single\u2010leg\u2010hop test LSI of\u2009\u2265\u200990% (OR 1.56; 95% CI 1.04\u20132.34; <jats:italic>P<\/jats:italic>\u2009=\u20090.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Older age (\u2265\u200925 years) and delayed primary ACLR (\u2265\u200912\u00a0months) reduced the odds, whereas a symmetrical (LSI\u2009\u2265\u200990%) 6\u2010month single\u2010leg\u2010hop test increased the odds of contralateral ACLR within 5 years of primary ACLR. Knowledge of the factors affecting the risk of contralateral ACLR is important when it comes to the appropriate counselling for primary ACLR. Patients should be advised regarding factors affecting the risk of contralateral ACLR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06759-6","type":"journal-article","created":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T00:47:15Z","timestamp":1633567635000},"page":"1828-1835","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Age, time from injury to surgery and hop performance after primary ACLR affect the risk of contralateral ACLR"],"prefix":"10.1002","volume":"30","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":[[2021,10,7]]},"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\/0363546514557245"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.3810\/psm.2011.09.1926"},{"key":"e_1_2_8_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512454414"},{"key":"e_1_2_8_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512459476"},{"key":"e_1_2_8_7_2","unstructured":"CristianiR ForssbladM EdmanG ErikssonK St\u00e5lmanAAge time from injury to surgery and quadriceps strength affect the risk of revision surgery after primary ACL reconstruction.Knee Surg Sports Traumatol Arthrosc(2021)10.1007\/s00167\u2010021\u201006517\u2010834971433"},{"key":"e_1_2_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.03.038"},{"key":"e_1_2_8_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005576\u20102"},{"key":"e_1_2_8_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005396\u20104"},{"key":"e_1_2_8_11_2","doi-asserted-by":"crossref","unstructured":"CristianiR MikkelsenC WangeP OlssonD St\u00e5lmanA Engstr\u00f6mBAutograft type affects muscle strength and hop performance after ACL reconstruction. 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