| Abstract ID |
| 20260086 |
| Category |
| Knee: ACL |
| Preferable Presentation |
| Poster |
| Title |
| ANTERIOR CRUCIATE LIGAMENT REINJURY MECHANISMS AND RISK FACTORS IN ATHLETES: A SCOPING REVIEW |
| Author |
|
| Presenter |
| Naufal reginald abiyasa |
| Abstract |
| Background Anterior cruciate ligament (ACL) reinjury, with reported rates of 15–30% following primary reconstruction, remains a major challenge in sports medicine. While primary ACL injuries have been extensively studied, evidence directly comparing primary and secondary injury mechanisms is limited. This gap restricts the development of rehabilitation strategies and return-to-sport criteria that adequately reflect the distinct risk profile of athletes with a prior ACL injury. Objectives This scoping review aimed to map and synthesize the existing literature examining differences between primary and secondary ACL injuries, including injury mechanisms, biomechanical patterns, psychological factors, and associated risk factors, in order to identify knowledge gaps and inform clinical practice in ACL reinjury prevention. Study Design This scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines.Comprehensive searches were performed in the Scopus database between 2021 and 2025. The search strategy combined terms related to anterior cruciate ligament injury, reinjury or secondary injury, and injury mechanisms, biomechanics, risk, or prevention. Eligible studies included peer-reviewed English-language articles examining primary versus secondary ACL injuries in competitive or recreational athletes aged 12–45 years. Case reports with fewer than 10 participants, cadaveric studies, studies focused solely on surgical techniques without analysis of injury mechanisms, and non-sport-related injuries were excluded. Two independent reviewers screened titles, abstracts, and full texts. Data extraction included study characteristics, participant demographics, injury mechanisms, biomechanical variables, psychological factors, and reported risk factors. A total of 98 articles were identified, of which eight studies met the inclusion criteria for direct comparison between primary and secondary ACL injuries. Result Across the included studies, secondary ACL injuries demonstrated distinct patterns compared with primary injuries. Video analysis indicated that secondary injuries occurred more frequently during landing tasks involving longer jump distances and higher hop frequency. Female athletes who sustained secondary injuries showed greater pre-injury jump performance, suggesting potentially maladaptive movement strategies following return to sport. Psychological factors, particularly fear of reinjury and kinesiophobia, were consistently elevated after primary ACL reconstruction, with reported prevalence ranging from 43% to 78%, and were associated with altered movement patterns and delayed return to sport. Biomechanical analyses revealed persistent asymmetries following reconstruction, including reduced knee flexion angles and increased reliance on the uninvolved limb. Adolescents demonstrated an increased risk of secondary injury, with skeletal maturity associated with higher rates of meniscal and chondral pathology within six months of the primary injury.Graft type and the use of lateral extra-articular procedures were also associated with reinjury risk. Returning to sport earlier than nine months after reconstruction was consistently linked to a higher risk of secondary ACL injury. Conclusions This scoping review demonstrates clear differences between primary and secondary ACL injuries, with secondary injuries linked to distinct biomechanical, psychological, and demographic risk factors. Female athletes, adolescents, and those returning to sport prematurely face a higher risk of reinjury. These findings support the need for comprehensive return-to-sport strategies that incorporate psychological readiness and sport-specific movement assessment alongside physical rehabilitation to reduce ACL reinjury risk. |