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Changes in Coronal Plane Alignment and Functional Outcomes Following Primary ACL Reconstruction: A Retrospective
Mehmet İnce1, Hasan Ulaş Oğur2, Hakan Çiçek3
1Department of Traumatology, Kocaeli Derince Training & Research Hospital, İbni Sina Mahallesi, Lojman Sokak, 41900 Derince, Kocaeli Türkiye.
Background:
The long‑term impact of primary anterior cruciate ligament (ACL) reconstruction on coronal limb alignment is still debated. We investigated mid‑term mechanical axis changes and their clinical correlates after single‑bundle hamstring ACL reconstruction.
Methods:
This retrospective cohort comprised 100 consecutive patients who underwent primary ACL reconstruction between 2013 and 2018. Standing long‑leg radiographs obtained at a mean 60 ± 14 months were used to measure hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint‑line convergence angle (JLCA) and mechanical axis deviation (MAD) in the operated and contralateral limbs. Functional outcome was assessed using the Tegner-Lysholm Knee Score. Paired t tests compared limbs, and Spearman correlations examined associations with clinical parameters (α = 0.05).
Results:
No significant differences were detected between reconstructed and contralateral knees for HKA (177.3° ± 3.3 vs 177.7° ± 3.1), mLDFA (87.6° ± 2.5 vs 87.4° ± 2.2), MPTA (85.6° ± 2.3 vs 85.6° ± 2.2), JLCA (1.11° ± 1.8 vs 0.72° ± 1.17) or MAD (5.96 ± 18.1 mm vs 3.68 ± 8.9 mm) (all p > 0.05). Varus MAD correlated with lower Tegner-Lysholm scores (r = -0.28, p = 0.01). Body‑mass index showed a moderate positive correlation with varus deviation (r = 0.32, p = 0.02). Meniscal lesions (n = 43) had no effect on alignment parameters.
Conclusions:
Primary ACL reconstruction maintained coronal alignment at 5‑year follow‑up. Nonetheless, varus deviation adversely affected functional outcomes, underscoring the importance of addressing postoperative malalignment.Trial Registration Not applicable.
Graphical Abstract:
The vs partial meniscectomy 100 primary ACL-reconstructed knees tracked to a 5-year follow-up. Mean hip-knee-ankle varus angles remained stable (1.5° → 1.7°, p = 0.28), confirming no progressive coronal deformity. Patients with residual varus > 3° showed lower Tegner-Lysholm scores, highlighting the functional impact of alignment.