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Factors associated with additional anterior cruciate ligament reconstruction and register comparison: a systematic review on the Scandinavian knee ligament registers
  1. Eleonor Svantesson1,
  2. Eric Hamrin Senorski2,
  3. Angelo Baldari3,
  4. Olufemi R. Ayeni4,
  5. Lars Engebretsen5,6,
  6. Francesco Franceschi3,
  7. Jon Karlsson1,7,
  8. Kristian Samuelsson1,7
  1. 1 Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
  2. 2 Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
  3. 3 Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
  4. 4 Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  5. 5 Orthopedic Clinic, Oslo University Hospital, University of Oslo, Oslo, Norway
  6. 6 OSTRC, The Norwegian School of Sports Sciences, Oslo, Norway
  7. 7 Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
  1. Correspondence to Eleonor Svantesson, Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-431 80, Sweden; eleonor.svantesson{at}


Objective To present an overview of the Scandinavian knee ligament registers with regard to factors associated with additional ACL reconstruction, and studies comparing the Scandinavian registers with other knee ligament registers.

Design Systematic review.

Data sources Four electronic databases: PubMed, EMBASE, the Cochrane Library and AMED were searched, and 157 studies were identified. Two reviewers independently screened titles, abstracts and full-text studies for eligibility. A modified version of the Downs and Black checklist was applied for quality appraisal.

Eligibility criteria for selecting studies Eligible studies were those published since the establishment of the Scandinavian registers in 2004, which reported factors associated with additional ACL reconstruction and compared data from other registers.

Results Thirty-one studies met the inclusion criteria and generally displayed good reporting quality. Adolescent age (<20 years) was the most common factor associated with additional ACL reconstruction. The choice of hamstring tendon graft compared with patella tendon, transportal femoral tunnel drilling, smaller graft diameter and utilisation of suspensory fixation devices were associated with additional ACL reconstruction. Concomitant cartilage injury decreased the likelihood of additional ACL reconstruction. Patient sex alone did not influence the likelihood. The demographics of patients undergoing ACL reconstruction in the Scandinavian registers are comparable to registers in other geographical settings. However, there are differences in surgical factors including the presence of intra-articular pathology and graft choice.

Summary The studies published from the Scandinavian registers in general have a high reporting quality when regarded as cohort studies. Several factors are associated with undergoing additional ACL reconstruction. The results from the registers may help facilitate treatment decisions.

  • acl
  • knee acl
  • anterior cruciate ligament
  • review
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  • Contributors ES, EHS and KS have substantial contributed to the acquisition of data, analysis of data and are responsible for drafting the work and revising it critically for important intellectual content. FF, ORA and AB have done substantial contributions to the conception and design of the work, including interpretation of data. LE and JK have done large contributions in revising and designing the manuscript. All authors have given their final approval of the manuscript to be published. In addition, all authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Not applicable.

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