{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:52:40Z","timestamp":1784854360501,"version":"3.55.0"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Anterior cruciate ligament tears and anterior cruciate ligament reconstruction (ACLR) are common in young athletes. The modifiable and non\u2010modifiable factors contributing to ACLR failure and reoperation are incompletely understood. The purpose of this study was to determine ACLR failure rates in a physically high\u2010demand population and identify the patient\u2010specific risk factors, including prolonged time between diagnosis and surgical correction, that portend failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A consecutive series of military service members with ACLR with and without concomitant procedures (meniscus [M] and\/or cartilage [C]) done at military facilities between 2008 and 2011 was completed via the Military Health System Data Repository. This was a consecutive series of patients without a history of knee surgery for two years prior to the primary ACLR. Kaplan\u2013Meier survival curves were estimated and evaluated with Wilcoxon test. Cox proportional hazard models calculated hazard ratios (HR) with 95% confidence intervals (95% CI) to identify demographic and surgical factors that influenced ACLR failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 2735 primary ACLRs included in the study, 484\/2,735 (18%) experienced ACLR failure within four years, including (261\/2,735) (10%) undergoing revision ACLR and (224\/2,735) (8%) due to medical separation. The factors that increased failure include Army Service (HR 2.19, 95% CI 1.67, 2.87),\u2009&gt;\u2009180\u00a0days from injury to ACLR (HR 1.550, 95% CI 1.157, 2.076), tobacco use (HR 1.429 95% CI 1.174, 1.738), and younger patient age (HR 1.024, 95% CI 1.004, 1.044).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The overall clinical failure rate of service members with ACLR is 17.7% with minimum four\u2010year follow\u2010up, where more patients are likely to fail due to revision surgery than medical separation. The cumulative probability of survival at 4 years was 78.5%. Smoking cessation and treating ACLR patients promptly are modifiable risk factors impacting either graft failure or medical separation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-023-07335-w","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T15:38:17Z","timestamp":1676993897000},"page":"3196-3203","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Survival of anterior cruciate ligament reconstructions in active\u2010duty military populations"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0811-1253","authenticated-orcid":false,"given":"Ashley B.","family":"Anderson","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Uniformed Services University\u2010Walter Reed National Military Medical Center Department of Surgery Division of Orthopaedics 8901 Wisconsin Ave 20814 Bethesda MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis J.","family":"Dekker","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Orthopaedics Eglin Air Force Base Eglin FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Pav","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Kennell &amp; Associates, Inc. Falls Church VA USA"},{"name":"<!--<label>4<\/label>--> Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy C.","family":"Mauntel","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> DoD\u2010VA Extremity Trauma and Amputation Center of Excellence Fort Bragg NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Provencher","sequence":"additional","affiliation":[{"name":"<!--<label>6<\/label>--> The Steadman Philippon Research Institute Vail CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Tokish","sequence":"additional","affiliation":[{"name":"<!--<label>7<\/label>--> Mayo Clinic Scottsdale AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musahl","family":"Volker","sequence":"additional","affiliation":[{"name":"<!--<label>8<\/label>--> Medical Center Department of Orthopaedic Surgery University of Pittsburgh Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sansone","sequence":"additional","affiliation":[{"name":"<!--<label>9<\/label>--> Department of Orthopaedics Sahlgrenska Academy Sahlgrenska University Hospital G\u00f6teborg Sweden"},{"name":"<!--<label>10<\/label>--> Gothenburg University G\u00f6teborg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Karlsson","sequence":"additional","affiliation":[{"name":"<!--<label>9<\/label>--> Department of Orthopaedics Sahlgrenska Academy Sahlgrenska University Hospital G\u00f6teborg Sweden"},{"name":"<!--<label>10<\/label>--> Gothenburg University G\u00f6teborg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan F.","family":"Dickens","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Uniformed Services University\u2010Walter Reed National Military Medical Center Department of Surgery Division of Orthopaedics 8901 Wisconsin Ave 20814 Bethesda MD USA"},{"name":"<!--<label>9<\/label>--> Department of Orthopaedics Sahlgrenska Academy Sahlgrenska University Hospital G\u00f6teborg Sweden"},{"name":"<!--<label>10<\/label>--> Gothenburg University G\u00f6teborg Sweden"},{"name":"<!--<label>11<\/label>--> Department of Orthopaedic Surgery Duke University Durham NC USA"},{"name":"<!--<label>12<\/label>--> John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy West Point NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,21]]},"reference":[{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usx007"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967116669309"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/163.1.17"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.00758"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000000792"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/156.3.118"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513490656"},{"key":"e_1_2_11_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517749850"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513490277"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515578836"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512458223"},{"key":"e_1_2_11_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010015\u20103830\u20102"},{"key":"e_1_2_11_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.asmr.2020.06.003"},{"key":"e_1_2_11_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514530866"},{"key":"e_1_2_11_16_2","first-page":"521","article-title":"Outcome after reconstruction of the anterior cruciate ligament in athletic patients","volume":"85","author":"Meighan AAS","year":"2003","journal-title":"Bone Joint J"},{"key":"e_1_2_11_17_2","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED.172.1.90"},{"key":"e_1_2_11_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967119S00102"},{"key":"e_1_2_11_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/JSA.0000000000000237"},{"key":"e_1_2_11_20_2","first-page":"118","article-title":"The Military ACL","volume":"32","author":"Tennent DJ","year":"2018","journal-title":"J Knee Surg"},{"key":"e_1_2_11_21_2","unstructured":"Office of the Under Secretary of Defense Personnel and Readiness.Population Representation in the Military Services: Fiscal Year 2018. Table D\u201012. Mean Age and Months of Completed Service of Active Component Enlisted Members FYs 1973\u20102018;Table D\u201018. Mean Age and Completed Months of Service of Active Component Commissioned Officers FYs 1973\u20102018; Published in 2020."}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-023-07335-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-023-07335-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-023-07335-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-023-07335-w","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T14:19:09Z","timestamp":1760883549000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-023-07335-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,21]]},"references-count":20,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1007\/s00167-023-07335-w"],"URL":"https:\/\/doi.org\/10.1007\/s00167-023-07335-w","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,21]]},"assertion":[{"value":"9 October 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 January 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Walter Reed National Military Medical Center Institutional Review Board.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}