Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: Reinjury, Contralateral Tears, Osteoarthritis Risk, and Emerging Artificial Intelligence Applications

Author(s): Joseph N Salama, Sylvia Arce, Diego A L Garcia*

Anterior cruciate ligament (ACL) reconstruction is among the most frequently performed orthopedic procedures in sports medicine in the United States. Although advances in surgical techniques and rehabilitation protocols have improved short-term outcomes, long-term complications remain common. Recurrent ACL injury, contralateral ligament rupture, persistent symptoms, and the development of post-traumatic osteoarthritis represent significant challenges affecting patient outcomes and healthcare utilization. Large multicenter registries, including the Multicenter Orthopaedic Outcomes Network (MOON), have provided valuable insights into long-term outcomes following ACL reconstruction. In parallel, advances in musculoskeletal imaging and artificial intelligence are increasingly contributing to improved diagnosis, prognostication, and surgical planning. This review examines the epidemiology of ACL injuries in the United States, biomechanical mechanisms of injury, outcomes following reconstruction, reinjury patterns, contralateral injury risk, osteoarthritis progression, and emerging technological innovations in sports medicine.