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PURPOSE: There remains a lack of consensus on the patient factors associated with graft rupture following anterior cruciate ligament (ACL) reconstruction. This study aimed to identify the rate of revision and surgeon-reported graft rupture and clarify the patient risk factors for failure. METHODS: Analysis was conducted on prospective data captured by the New Zealand ACL registry. All primary isolated ACL reconstructions recorded between April 2014 and December 2018 were reviewed to identify the rate of revision and surgeon-reported graft rupture. Univariate and multivariate survival analysis was performed to identify patient factors associated with revision and graft rupture. RESULTS: A total of 7402 primary isolated ACL reconstructions were reviewed and had a mean follow-up time of 23.1 (SD ± 13.9) months. There were 258 surgeon-reported graft ruptures (3.5%) of which 175 patients underwent subsequent revision ACL reconstruction (2.4%). Patients younger than 18 years had the highest risk of revision (adjusted HR = 7.29, p < 0.001) and graft rupture (adjusted HR = 4.26, p < 0.001) when compared to patients aged over 36 years. Male patients had a higher risk of revision (adjusted HR = 2.00, p < 0.001) and graft rupture (adjusted HR = 1.70, p < 0.001) when compared to their female counterparts. Patients who underwent ACL reconstruction within 6 months of their injury had a two times increased risk of revision compared to patients who had surgery after 12 months (adjusted HR = 2.15, p = 0.016). CONCLUSION: Younger age, male sex and a shorter injury-to-surgery time interval increased the risk of revision, while younger age and male sex increased the risk of surgeon-reported graft rupture. LEVEL OF EVIDENCE: II.

Original publication




Journal article


Knee surg sports traumatol arthrosc

Publication Date





2194 - 2202


ACL reconstruction, Graft rupture, National registry, Revision ACL, Adolescent, Adult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Female, Humans, Male, New Zealand, Postoperative Complications, Prospective Studies, Registries, Reoperation, Risk Factors, Rupture, Surgeons, Young Adult