Anatomical risk mapping in ACL reconstruction: Radiological predictors of graft rerupture
Yusuf Sülek1, Abdurrahman Demirhan2, Yusuf Altuntaş2
1Esenyurt Necmi Kadıoğlu State Hospital, The Department of Orthopedics and Traumatology, İstanbul, Turkey.
Purpose:
The aim of this study was to compare the anatomical parameters in patients with anterior cruciate ligament (ACL) rerupture after reconstruction with those without.
Methods:
This retrospective study included patients who underwent primary ACL reconstruction using a quadrupled semitendinosus and gracilis tendon autograft between January 2017 and January 2021. Patients who required revision due to rerupture (n = 51) were then compared with age- and sex-matched controls without rerupture (n = 52). Radiological parameters were measured using standard lateral knee radiographs and magnetic resonance imaging (MRI). Measurements included femoral/tibial tunnel angles (FTA/TTA), tibial tunnel anteroposterior position (TTAPL), posterior tibial slope (PTS), lateral tibial plateau subluxation (LTPSu), lateral femoral condyle index (LFCI), as well as various other anatomical parameters such as tibial plateau morphology, meniscal pathology, and notch dimensions. Correlation and logistic regression analyses were performed.
Results:
Significant differences were observed between the rerupture and control groups in TTA (71.7 ± 9.2 vs. 78.4 ± 12.8; p = 0.046), TTAPL (0.4 ± 0.1 vs. 0.4 ± 0.1; p = 0.043), LTPS (8.0 ± 4.7 vs. 5.8 ± 4.2; p = 0.015), MTPSu (2.1 ± 2.2 vs. 1.5 ± 2.4; p = 0.029), and LFCI (0.8 ± 0.1 vs. 0.7 ± 0.0; p < 0.001). In the final logistic regression model (χ² = 52.969; Nagelkerke R² = 0.536), TTA (OR = 0.93, p = 0.007), TTAPL (OR = 1.088, p = 0.088), LTS (OR = 1.116, p = 0.043), and LFCI (OR = 6.36 × 10100, p = 0.001) remained as independent predictors. The overall classification accuracy of the model was 79.6%.
Conclusions:
Several anatomical parameters-including a smaller TTA, more anterior tibial tunnel positioning, increased lateral tibial plateau slope, and a higher lateral femoral condyle index-were found to be independently associated with ACL graft rerupture. These radiological risk factors should be carefully evaluated during surgical planning and postoperative follow-up to reduce the likelihood of graft failure.
Level Of Evidence:
Level III, retrospective comparative study.
