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Dynamic knee valgus as a predictor of graft rerupture after anterior cruciate ligament reconstruction: Influence of sex and graft type

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dc.contributor.authorGonzalez, Waldo
dc.contributor.authorRiquelme, Juan
dc.contributor.authorBarba, Diego
dc.contributor.authorErskine, Daniela
dc.contributor.authorVenegas, Rodrigo
dc.contributor.authorCalvo, Rafael
dc.contributor.authorFigueroa, David
dc.date.accessioned2026-04-27T16:06:37Z
dc.date.available2026-04-27T16:06:37Z
dc.date.issued2026
dc.description.abstractIntroduction: Dynamic knee valgus has been identified as a potential risk factor for anterior cruciate ligament (ACL) injury, but its role in predicting graft failure or contralateral rupture after anterior cruciate ligament reconstruction (ACLR) remains unclear. The purpose of this study was to evaluate dynamic valgus (DV) as a predictor of graft re-rupture and contralateral ACL injury following ACLR, and to explore whether graft type influences this association. Methods: Prospective cohort study was conducted patients who underwent primary ACLR between 2020 and 2024. Patients with multiligament injuries, osteotomies, or revision surgeries were excluded. DV was measured during a standardized return-to-sport (RTS) drop jump test. Logistic regression was performed to assess associations with graft rerupture and contralateral ACL injury, adjusting for age, sex, body mass index (BMI), and graft type. Receiver operating characteristic (ROC) analysis was used to evaluated discriminative ability. Results: A total of 137 patients completed follow-up at a mean of 3.0 ​± ​1.2 years. Most patients were male (75.9%), with a mean age of 26.7 years. Ten patients (7.3%) sustained a graft re-rupture and nine (6.6%) a contralateral rupture. The DV was an independent predictor of graft rerupture (adjusted odds ratio [aOR]: 1.07; 95% confidence interval [CI]: 1.001-1.15). In sex-stratified analyses, this association was statistically significant only among men (aOR: 1.13; 95% CI: 1.02-1.24), with an area under the curve (AUC) of 0.76. A threshold between 18° and 20° yielded a balanced sensitivity and specificity of 71% and 73%, respectively. No statistically significant differences in DV were observed across graft types. Conclusion: DV is an independent predictor of graft rerupture after ACLR, particularly among men, where valgus angles above 18-20° markedly increase the risk of failure. These findings support the integration of DV assessment into postoperative follow-up to identify high-risk patients and to inform graft selection and rehabilitation strategies. Level of evidence: III
dc.description.versionVersión Aceptada
dc.identifier.citationGonzalez W, Riquelme JP, Barba D, et al. Dynamic knee valgus as a predictor of graft rerupture after anterior cruciate ligament reconstruction: Influence of sex and graft type. J ISAKOS. 2026;16:101034. doi:10.1016/j.jisako.2025.101034
dc.identifier.doihttps://doi.org/doi:10.1016/j.jisako.2025.101034
dc.identifier.urihttps://hdl.handle.net/11447/10713
dc.language.isoen
dc.subjectAnterior cruciate ligament reconstruction
dc.subjectBiomechanics
dc.subjectDrop jump
dc.subjectDynamic valgus
dc.subjectQuadriceps tendon graft
dc.subjectSemitendinosus tendon graft
dc.titleDynamic knee valgus as a predictor of graft rerupture after anterior cruciate ligament reconstruction: Influence of sex and graft type
dc.typeArticle
dcterms.accessRightsAcceso Abierto
dcterms.sourceJournal of ISAKOS : joint disorders & orthopaedic sports medicine
dspace.entity.typePublication

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