Body Mass Index and the Risk of Repeat Revision Anterior Cruciate Ligament Reconstruction Failure

Background: There is growing interest in understanding the correlates of revision anterior cruciate ligament reconstruction (ACLR) failure, and conflicting evidence exists regarding body mass index (BMI) as a risk factor. Purpose: To evaluate the relationship between BMI and revision ACLR failure. Study Design: Case-control study; Level of evidence, 3. Methods: Patients aged 16 years or older who underwent revision ACLR between 2012 and 2021 with a minimum 2-year follow-up were included. Patients with inadequate follow-up, incomplete medical records, or concomitant lateral extra-articular tenodesis, anterolateral ligament reconstruction, osteotomy, osteochondral transplant, or multiligamentous injury were excluded. BMI was classified as normal (18.5 ≤ BMI < 25.0 kg/m 2 ), overweight (25.0 ≤ BMI < 30.0 kg/m 2 ), and obese 30.0 ≤ BMI < 35.0 kg/m 2 ). Intraoperative data, concomitant injuries, complications, graft failure, and second revision ACLR data were collected. Results: A total of 174 patients who underwent revision ACLR were included; 37 (21.3%; 26 male, 11 female) experienced revision ACLR failure while 137 (78.7%; 83 male, 54 female) did not. The mean BMI did not differ between patients with and without revision ACLR failure. There was no difference in revision ACLR failure when stratifying patients by normal (n = 81), overweight (n = 57), or obese (n = 36) BMI. Conclusion: There is no significant relationship demonstrated between BMI and the risk of revision ACLR failure.