Original Article| Volume 30, ISSUE 7, P803-810, July 2014

Download started.


Results From the Swedish National Anterior Cruciate Ligament Register


      The purpose of the study was to analyze the baseline variables and clinical outcomes for almost 24,000 patients entered into the Swedish National ACL Register between January 2005 and December 2012.


      The register consists of 2 parts: 1 section in which surgeons report baseline and surgical data and 1 section in which patients report the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EQ-5D score before and 1, 2, and 5 years after surgery.


      By December 2012, 23,744 patients had been entered into the surgeons’ part of the register. The female-male ratio in the register is 42:58. The mean age at primary anterior cruciate ligament (ACL) reconstruction was 26 years (SD, 11 years) and 28 years (SD, 9 years) for the female and male patients, respectively. The ACL injury occurred during soccer in 36% of the female patients and 49% of the male patients. In 2012, 95% of the primary ACL reconstructions were performed using hamstring tendon autografts. For patients who had a minimum of 5 years’ follow-up, the revision rate was 3.3% and the contralateral reconstruction rate was 3.8%. On all follow-up occasions up to 5 years, patients who had undergone revision had a significantly (P < .001) poorer outcome than those who had undergone primary unilateral ACL reconstructions in all KOOS and EQ-5D dimensions. On all follow-up occasions, smokers obtained significantly poorer scores than nonsmokers in terms of both the KOOS (P < .008) and the EQ-5D (P < .024).


      Soccer is the most common cause of injury in both female and male patients, and patients undergoing revisions fare less well than those undergoing primary unilateral ACL reconstructions, as well as bilateral reconstructions. Furthermore, smokers fare less well than nonsmokers. The cumulative risk of an ACL revision or contralateral ACL reconstruction during a 5-year period is approximately 7%. For patients aged younger than 19 years, the cumulative risk is significantly higher.

      Level of Evidence

      Level II, retrospective prognostic study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ageberg E.
        • Forssblad M.
        • Herbertsson P.
        • Roos E.M.
        Sex differences in patient-reported outcomes after anterior cruciate ligament reconstruction: Data from the Swedish knee ligament register.
        Am J Sports Med. 2010; 38: 1334-1342
        • Ahldén M.
        • Samuelsson K.
        • Sernert N.
        • Forssblad M.
        • Karlsson J.
        • Kartus J.
        The Swedish National Anterior Cruciate Ligament Register: A report on baseline variables and outcomes of surgery for almost 18,000 patients.
        Am J Sports Med. 2012; 40: 2230-2235
        • Lind M.
        • Menhert F.
        • Pedersen A.B.
        The first results from the Danish ACL reconstruction registry: Epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 117-124
        • Granan L.P.
        • Forssblad M.
        • Lind M.
        • Engebretsen L.
        The Scandinavian ACL registries 2004-2007: Baseline epidemiology.
        Acta Orthop. 2009; 80: 563-567
        • Spindler K.P.
        • Parker R.D.
        • Andrish J.T.
        • et al.
        Prognosis and predictors of ACL reconstructions using the MOON cohort: A model for comparative effectiveness studies.
        J Orthop Res. 2013; 31: 2-9
        • Maletis G.B.
        • Inacio M.C.
        • Funahashi T.T.
        Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry.
        Am J Sports Med. 2013; 41: 2090-2098
        • Lyman S.
        • Koulouvaris P.
        • Sherman S.
        • Do H.
        • Mandl L.A.
        • Marx R.G.
        Epidemiology of anterior cruciate ligament reconstruction: Trends, readmissions, and subsequent knee surgery.
        J Bone Joint Surg Am. 2009; 91: 2321-2328
        • Roos E.M.
        • Roos H.P.
        • Ekdahl C.
        • Lohmander L.S.
        Knee injury and Osteoarthritis Outcome Score (KOOS)—Validation of a Swedish version.
        Scand J Med Sci Sports. 1998; 8: 439-448
        • Roos E.M.
        • Roos H.P.
        • Lohmander L.S.
        • Ekdahl C.
        • Beynnon B.D.
        Knee Injury and Osteoarthritis Outcome Score (KOOS)—Development of a self-administered outcome measure.
        J Orthop Sports Phys Ther. 1998; 28: 88-96
        • Brooks R.
        EuroQol: The current state of play.
        Health Policy. 1996; 37: 53-72
        • Frobell R.B.
        • Svensson E.
        • Gothrick M.
        • Roos E.M.
        Self-reported activity level and knee function in amateur football players: The influence of age, gender, history of knee injury and level of competition.
        Knee Surg Sports Traumatol Arthrosc. 2008; 16: 713-719
        • Hettrich C.M.
        • Dunn W.R.
        • Reinke E.K.
        • Spindler K.P.
        The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: Two- and 6-year follow-up results from a multicenter cohort.
        Am J Sports Med. 2013; 41: 1534-1540
        • Wasserstein D.
        • Khoshbin A.
        • Dwyer T.
        • et al.
        Risk factors for recurrent anterior cruciate ligament reconstruction: A population study in Ontario, Canada, with 5-year follow-up.
        Am J Sports Med. 2013; 41: 2099-2107
        • Lind M.
        • Menhert F.
        • Pedersen A.B.
        Incidence and outcome after revision anterior cruciate ligament reconstruction: Results from the Danish registry for knee ligament reconstructions.
        Am J Sports Med. 2012; 40: 1551-1557
        • Rahr-Wagner L.
        • Thillemann T.M.
        • Pedersen A.B.
        • Lind M.
        Comparison of hamstring tendon and patellar tendon grafts in anterior cruciate ligament reconstruction in a nationwide population-based cohort study: Results from the Danish Registry of Knee Ligament Reconstruction.
        Am J Sports Med. 2014; 42: 278-284
        • Walden M.
        • Atroshi I.
        • Magnusson H.
        • Wagner P.
        • Hagglund M.
        Prevention of acute knee injuries in adolescent female football players: Cluster randomised controlled trial.
        BMJ. 2012; 344: e3042
        • Frobell R.B.
        • Roos H.P.
        • Roos E.M.
        • Roemer F.W.
        • Ranstam J.
        • Lohmander L.S.
        Treatment for acute anterior cruciate ligament tear: Five year outcome of randomised trial.
        BMJ. 2013; 346: f232
        • Fältström A.
        • Hägglund M.
        • Kvist J.
        Patient-reported knee function, quality of life, and activity level after bilateral anterior cruciate ligament injuries.
        Am J Sports Med. 2013; 41: 2805-2813
        • Sanden B.
        • Forsth P.
        • Michaelsson K.
        Smokers show less improvement than nonsmokers two years after surgery for lumbar spinal stenosis: A study of 4555 patients from the Swedish spine register.
        Spine (Phila Pa 1976). 2011; 36: 1059-1064
        • Lee J.J.
        • Patel R.
        • Biermann J.S.
        • Dougherty P.J.
        The musculoskeletal effects of cigarette smoking.
        J Bone Joint Surg Am. 2013; 95: 850-859
        • Mills E.
        • Eyawo O.
        • Lockhart I.
        • Kelly S.
        • Wu P.
        • Ebbert J.O.
        Smoking cessation reduces postoperative complications: A systematic review and meta-analysis.
        Am J Med. 2011; 124: 144-154.e8
        • Ahldén M.
        • Sernert N.
        • Karlsson J.
        • Kartus J.
        A prospective randomized study comparing double- and single-bundle techniques for anterior cruciate ligament reconstruction.
        Am J Sports Med. 2013; 41: 2484-2491
        • Karlsson J.
        • Irrgang J.J.
        • van Eck C.F.
        • Samuelsson K.
        • Mejia H.A.
        • Fu F.H.
        Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 2: Clinical application of surgical technique.
        Am J Sports Med. 2011; 39: 2016-2026
        • Samuelsson K.
        • Andersson D.
        • Ahldén M.
        • Fu F.H.
        • Musahl V.
        • Karlsson J.
        Trends in surgeon preferences on anterior cruciate ligament reconstructive techniques.
        Clin Sports Med. 2013; 32: 111-126
        • Engebretsen L.
        • Forssblad M.
        Why knee ligament registries are important.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 115-116
        • Rahr-Wagner L.
        • Thillemann T.M.
        • Lind M.C.
        • Pedersen A.B.
        Validation of 14,500 operated knees registered in the Danish Knee Ligament Reconstruction Register: Registration completeness and validity of key variables.
        Clin Epidemiol. 2013; 5: 219-228

      Linked Article

      • Errata
        ArthroscopyVol. 30Issue 8
        • Preview
          In the article “Results From the Swedish National Anterior Cruciate Ligament Register” by Kvist et al. in the July 2014 issue (Arthroscopy 2014;30:803-810), there were minor errors in Table 2. The corrected table appears below.
        • Full-Text
        • PDF