{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T03:35:15Z","timestamp":1792121715424,"version":"4.4.0"},"reference-count":38,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"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":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Anterior cruciate ligament (ACL) injuries are prevalent among elite athletes, particularly in high-impact sports. While ACL reconstruction (ACLR) is the gold-standard treatment, graft failure rates can exceed 30% in high-risk populations. Moreover, associated meniscal injuries often necessitate secondary surgical interventions. Implementing a systematic surgical approach, including advanced meniscal repair techniques and lateral extra-articular procedures, may enhance outcomes and reduce reoperation rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose\/Hypothesis:<\/jats:title>\n                    <jats:p>This study aimed to assess the effect of a systematic approach to ACLR on secondary surgery rates and ACL graft survival among professional athletes. It was hypothesized that this approach would significantly reduce secondary surgeries and ACL graft failures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective analysis of data from the SANTI database, focusing on professional athletes who underwent primary ACLR performed by a single senior surgeon between 2003 and 2020, was performed. Patients were categorized into 2 groups: those before October 2012 and those treated after the introduction of a systematic surgical approach. Primary outcomes included ACL graft rupture rates and secondary surgery rates (meniscectomy and revision ACLR). Cox proportional hazards models were used to evaluate risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The final cohort comprised 342 patients, with 130 treated before October 2012 and 212 after the introduction of a systematic protocol. Athletes treated after October 2012 exhibited a significantly lower rate of secondary surgery (30.0% before vs 16.5% after,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0174) and reduced ACL graft rupture rates (13.1% before vs 6.6% after,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0039). The 7-year graft survival rate improved from 86.9% before October 2012 to 93.3% after that month. Notably, younger athletes (&lt;21 years) had an elevated risk of reoperation (hazard ratio, 2.090) and graft failure (hazard ratio, 2.224). The systematic approach also led to a significant reduction in the rate of secondary medial meniscectomy (10.8% vs 3.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0052).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A systematic approach to ACLR significantly reduced secondary surgeries and graft failure rates in elite athletes. These findings support the routine use of advanced meniscal repair techniques and lateral extra-articular procedures to enhance long-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671251397660","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T17:37:35Z","timestamp":1766165855000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"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-up of 100 Months From the SANTI Study Group"],"prefix":"10.1177","volume":"13","author":[{"given":"Graeme P.","family":"Hopper","sequence":"first","affiliation":[{"name":"NHS Lanarkshire University Hospitals, Department of Trauma and Orthopaedic Surgery, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Haddock","sequence":"additional","affiliation":[{"name":"NHS Lanarkshire University Hospitals, Department of Trauma and Orthopaedic Surgery, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Pioger","sequence":"additional","affiliation":[{"name":"Hospital Ambroise-Par\u00e9, Department of Orthopedic Surgery, Boulogne-Billancourt, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corentin","family":"Philippe","sequence":"additional","affiliation":[{"name":"Centre Orthop\u00e9dique Santy, Lyon, France. 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