Independent Predictors of Revision After Primary Hamstring ACL Reconstruction: Younger Age, Soccer, Smoking, Meniscal Injury, and Absence of the “Monoloop” Lateral Extra-articular Tenodesis in 748 Patients
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Lateral extra-articular tenodesis reduces graft failure risk in select cases of anterior cruciate ligament reconstruction (ACLR), but the effect of the “monoloop” lateral extra-articular tenodesis (mLET) in large cohorts is uncertain. Purpose: To quantify the cumulative incidence of revision after primary hamstring tendon ACLR, identify independent patient- and injury-related predictors, and evaluate whether mLET was associated with lower revision risk. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive primary hamstring tendon autograft ACLRs at a single tertiary center (2010-2015) were retrospectively reviewed; patients underwent isolated ACLR or ACLR + mLET at surgeon discretion. The endpoint was revision ACLR. Five a priori covariates (age <25 years, soccer, current smoking, meniscal injury, mLET) were analyzed with a multivariable Cox model (primary), a sensitivity logistic model, and Kaplan-Meier/log-rank testing. Results: Of 748 patients (mLET, n = 211; no mLET, n = 537), mLET group follow-up was shorter (median, 31 vs 57 months; P < .001). The revision rate was 3.3% (25/748) and the median time to revision was 18 months (IQR, 11-29), with 36% of revisions occurring within 12 months. Univariate associations with age <25 years, soccer, smoking, and meniscal injury were all significant ( P < .05). In the primary Cox model, all 5 covariates were independent predictors of revision: age <25 years (adjusted hazard ratio [aHR], 24.94; P < .001), absence of mLET (aHR, 4.84; P = .012), soccer (aHR, 3.53; P = .004), meniscal injury (aHR, 2.49; P = .029), and smoking (aHR, 2.48; P = .031). Kaplan-Meier 60-month survival for the overall cohort was 96.7%; the unadjusted mLET comparison was not significant (log-rank P = .174). The logistic model was concordant, including the absence of mLET (aOR, 7.38; P = .002). Conclusion: Overall, revision occurred in 3.3% of patients. Younger age (<25 years) and soccer were the strongest predictors, with smoking and meniscal injury also independent predictors. After multivariable adjustment for the measured covariates, the absence of mLET was independently associated with higher revision risk in the Cox (aHR, 4.84) and logistic (adjusted odds ratio, 7.38) models, whereas the unadjusted Kaplan-Meier comparison was not significant.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W7225428271