Survival of anterior cruciate ligament reconstructions in active-duty military populations

Ashley B. Anderson*, Travis J. Dekker, Veronika Pav, Timothy C. Mauntel, Matthew T. Provencher, John M. Tokish, Musahl Volker, Michael Sansone, Jon Karlsson, Jonathan F. Dickens

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: Anterior cruciate ligament tears and anterior cruciate ligament reconstruction (ACLR) are common in young athletes. The modifiable and non-modifiable 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-demand population and identify the patient-specific risk factors, including prolonged time between diagnosis and surgical correction, that portend failure. Methods: 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–Meier 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. Results: 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), > 180 days 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). Conclusion: The overall clinical failure rate of service members with ACLR is 17.7% with minimum four-year follow-up, 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. Level of evidence: Level III.

Original languageEnglish
Pages (from-to)3196-3203
Number of pages8
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number8
StatePublished - Aug 2023
Externally publishedYes


  • ACL
  • ACL outcomes
  • ACL survival
  • Risk factors for failure


Dive into the research topics of 'Survival of anterior cruciate ligament reconstructions in active-duty military populations'. Together they form a unique fingerprint.

Cite this