Evidence map›Paper›PMID 42394809›Full record

ReviewOrthopaedic journal of sports medicine2026

Comparison of Return-to-Sport and Patient-Reported Outcomes Between Primary and Revision ACL Reconstruction: An Updated Systematic Review and Meta-analysis.

Min-Hao Sun, Ying-Chen Kuo, Chih-Hao Chiu, Chin-Shan Ho, Alvin Chao-Yu Chen, Yi-Sheng Chan, Cheng-Pang Yang

Abstract readReview
In one paragraph

Review in Orthopaedic journal of sports medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Min-Hao SunLinkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.ORCID https://orcid.org/0009-0001-0109-7700
Ying-Chen KuoDepartment of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Chih-Hao ChiuDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.ORCID https://orcid.org/0000-0001-9415-5115
Chin-Shan HoGraduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan.
Alvin Chao-Yu ChenDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Yi-Sheng ChanBone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
Cheng-Pang YangGraduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Anterior cruciate ligament (ACL) injuries are among the most common sports-related injuries worldwide. Primary ACL reconstruction (PACLR) is the standard treatment, but graft failure may necessitate revision ACLR (RACLR). Even though RACLR restores knee stability, outcomes such as return to sport (RTS) and patient-reported measures are thought to be inferior compared with PACLR. While RACLR is widely recognized as resulting in inferior clinical outcomes compared with PACLR, there remains a need for an updated, head-to-head meta-analysis to precisely quantify the magnitude of these disparities in terms of RTS and specific patient-reported outcomes (PROs) across larger patient populations. Purpose/Hypothesis: This study aimed to compare RTS and PROs between PACLR and RACLR. It was hypothesized that RACLR would result in significantly lower RTS rates and inferior PROs compared with PACLR. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic search was conducted in PubMed and Cochrane Library (August 26, 2025) using terms related to "primary,""revision,""anterior cruciate ligament,""reconstruction," and "outcome." Inclusion criteria included (1) comparative studies between PACLR and RACLR, (2) reporting of RTS or PROs through outcome measures (subjective International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Lysholm, and Tegner), and (3) randomized controlled trials, cohort, cross-sectional, or case-control studies. Exclusion criteria comprised duplicates, reviews, case reports, abstracts, or letters. Two independent reviewers performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale and Joanna Briggs Institute checklist. Data on RTS (categorical) were analyzed using risk difference (RD) and PROs (continuous) using mean difference (MD). Random- or fixed-effects models were applied based on heterogeneity. Analyses were conducted with RevMan Web. Results: A total of 22 studies were included, comprising a total of 24,773 patients (22,767 PACLR and 2006 RACLR). While no significant difference was observed between groups in overall RTS rates (RD, 0.09; 95% CI, -0.02 to 0.19; Conclusion: Compared with PACLR, RACLR demonstrated similar overall RTS rates but significantly lower RTS-S and consistently worse PROs. While revision surgery can restore function for daily living, substantial limitations remain in sports performance and quality of life.

Indexed as

anterior cruciate ligament reconstructionmeta-analysispatient-reported outcomereturn to sportrevision surgerysystematic review

Identifiers

PMID42394809
PMCPMC13323652

What Socratic holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.