Association between tibiofemoral bone and meniscus morphology and dynamic tibiofemoral movements during jump-landing tasks in patients following ACL reconstruction.

PURPOSE: To investigate whether tibiofemoral bone and meniscus morphology were associated with dynamic anterior tibial translation (ATTd) and internal tibial rotation (ITRd) during jump-landing tasks in anterior cruciate ligament (ACL)-reconstructed knees. Results may provide some guidance on the use of additional surgical procedures alongside (revision) ACL reconstruction (ACLR).

METHODS: Patients who underwent primary ACLR were included. Morphological features were measured using pre-surgery magnetic resonance images of the operated knee. Dependent variables included ATTd and ITRd during the landing of the single-leg hop for distance (SLHD) and side hop (SH), measured with three-dimensional optoelectronic motion capture. Univariate statistical parametric mapping regression analyses were conducted with morphological features as predictors.

RESULTS: Thirty patients were included at 4.7 ± 1.8 years post-ACLR (age: 31.0 ± 4.8 years). Steeper sagittal-plane lateral posterior tibial slope and greater medial-lateral difference in posterior tibial slope were significantly associated with less ATTd (peak r = -0.75; p = 0.048) and greater ITRd (peak r = 0.75; p = 0.047) during the SLHD and SH, but only in ACL-reconstructed knees with a flat medial tibial plateau (-2° to +2°; n = 13 subgroup analysis). Steeper coronal-plane tibial slope was significantly associated with less ATTd during the SLHD (peak r = -0.45; p = 0.049), and with greater ITRd during the SH (peak r = 0.47; p = 0.047). Smaller lateral meniscal slope of the posterior horn was significantly associated with greater ITRd during the SLHD (peak r = -0.46; p = 0.047). Greater lateral femoral condyle ratio was significantly associated with greater ITRd during the SLHD (peak r = 0.46; p = 0.04) and SH (peak r = 0.56; p = 0.006).

CONCLUSIONS: The observed associations with greater ITRd warrant further investigation into the potential role of anterolateral corner reconstruction alongside (revision) ACLR in patients with these morphological features. Since associations between posterior tibial slopes and ITRd depended on a flat medial plateau, the role of slope-reducing tibial osteotomy appears limited, as these procedures typically do not selectively target a single plateau.

LEVEL OF EVIDENCE: Level II.