{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:02:28Z","timestamp":1791936148101,"version":"4.3.4"},"reference-count":48,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Favorable outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) are often gauged by successful return to play (RTP), a low incidence of subsequent ACL injury, and positive patient-reported outcomes. Level 1 sports place the highest demands on the knee by requiring frequent pivoting, changes in direction, and jumping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To analyze the outcomes of primary ACLR in level 1 athletes and identify pre- and intraoperative factors associated with RTP, ipsilateral ACL reinjury, contralateral ACL injury, and International Knee Documentation Committee (IKDC) score at 5 years postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A consecutive cohort of 1432 patients who underwent primary ACLR by 2 orthopaedic surgeons were prospectively evaluated. The RTP rate, incidence of ipsilateral\/contralateral ACL injury, and IKDC score were analyzed at 5 years. Comparative analysis of clinical variables was performed between those who achieved favorable outcomes and those who did not. Outcomes at 5 and 2 years were also compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean age was 24.3 \u00b1 7.3 years (males: 75%, females: 25%). Gaelic football was the predominant sport (40%), followed by soccer (19%). The RTP rate was 87.4%, with 59.8% of athletes still playing at an equivalent or higher level at 5 years. The incidence of ipsilateral reinjury for athletes who resumed level 1 sport was 4.3% for bone\u2013patellar tendon\u2013bone (BPTB) autografts with screw fixation and 19.7% for hamstring tendon (HT) autografts with EndoButton and screw fixation. The incidence of contralateral ACL injury was 13.7%. The mean IKDC score at 5 years (86.6 \u00b1 10.9) was comparable to that at 2 years (86.8 \u00b1 10.1). Patients were more likely to RTP with each year of decreasing age (OR, 1.06;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), with a higher preoperative Marx score (OR, 1.08;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) or a higher 5-year IKDC score (OR, 1.06;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). The risk of ipsilateral ACL reinjury increased each year of decreasing age (OR, 1.11;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) or when an HT autograft was used (OR, 5.56;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Younger age was also associated with contralateral ACL injury (OR, 1.1;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Female sex, older age, concomitant meniscal\/chondral injuries, and lower preoperative Anterior Cruciate Ligament Return to Sport after Injury scores were associated with lower IKDC scores at 5 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Most patients could return to level 1 sports, although their performance level was impacted. Those who returned to sport maintained their performance level over the 5 years. The ipsilateral reinjury rate for BPTB autografts with screws was significantly lower than that for HT autografts with EndoButton and screw fixation. Most ACL reinjuries occurred between 2 and 5 years of follow-up. Younger patients had an increased risk of a subsequent ACL injury to either knee, regardless of graft type. IKDC scores were lower in female patients, older patients, and those with concomitant meniscal\/cartilage injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration:<\/jats:title>\n                    <jats:p>NCT02771548 (ClinicalTrials.gov identifier).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465241313386","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T17:12:56Z","timestamp":1738948376000},"page":"777-790","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":20,"title":["Primary Anterior Cruciate Ligament Reconstruction in Level 1 Athletes: Factors Associated With Return to Play, Reinjury, and Knee Function at 5 Years of Follow-up"],"prefix":"10.1177","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9713-9057","authenticated-orcid":false,"given":"Timothy","family":"McAleese","sequence":"first","affiliation":[{"name":"RCSI University of Medicine and Health Sciences, Dublin, Ireland"},{"name":"UPMC Sports Surgery Clinic, Santry Demesne, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Welch","sequence":"additional","affiliation":[{"name":"UPMC Sports Surgery Clinic, Santry Demesne, Dublin, Ireland"},{"name":"School of Health and Human Performance, Dublin City University, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0434-1489","authenticated-orcid":false,"given":"Enda","family":"King","sequence":"additional","affiliation":[{"name":"Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davood","family":"Roshan","sequence":"additional","affiliation":[{"name":"Department of Statistics, National University of Ireland Galway, Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niamh","family":"Keane","sequence":"additional","affiliation":[{"name":"School of Health and Human Performance, Dublin City University, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2015-8967","authenticated-orcid":false,"given":"Kieran A.","family":"Moran","sequence":"additional","affiliation":[{"name":"School of Health and Human Performance, Dublin City University, Dublin, Ireland"},{"name":"Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Jackson","sequence":"additional","affiliation":[{"name":"UPMC Sports Surgery 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