Purpose To clarify the correlation between postoperative anterior tibial subluxation (ATS) and clinical outcomes and identify the factors that influence postoperative ATS following anatomical anterior cruciate ligament (ACL) reconstruction. Methods Data of patients who underwent primary anatomical ACL reconstruction between 2012 and 2022 and postoperative magnetic resonance imaging over 2 years after surgery were enrolled. The ATS values for the medial and lateral compartments were measured on pre‐ and postoperative magnetic resonance imaging. Correlations between the postoperative clinical outcomes and postoperative ATS were analyzed. Multivariate regression analysis was performed to reveal the independent risk factors for the postoperative ATS among patients’ demographic data and parameters that correlated with the postoperative ATS. Results Overall, 208 patients with follow‐up duration of at least 2 years were included. Postoperative lateral ATS was significantly increased compared with its preoperative counterparts (2.5 ± 4.1 mm, 95% confidence interval CI 2.0‐3.1 vs. 3.2 ± 3.1 mm, 95% CI 2.8‐3.7, P = .01), whereas no significant difference was found in the medial ATS (0.7 ± 2.9 mm, 95% CI 0.3‐1.1 vs. 0.8 ± 2.2 mm, 95% CI 0.5‐1.1, P = .55). Postoperative medial ATS was significantly correlated with the postoperative Lysholm score ( r = −0.19, P 3 months from injury) (estimate = 0.594, 95% CI 0.047‐1.140, P = .033), medial meniscus lesions ((estimate = 0.627, 95% CI 0.076‐1.178, P = .026), and preoperative medial ATS (estimate = 0.394, 95% CI 0.292‐0.495, P < .001) as independent risk factors for postoperative medial ATS and the preoperative lateral ATS (estimate = 0.313, 95% CI 0.193‐0.432, P < .001) as an independent risk factor for postoperative lateral ATS. Conclusions Greater preoperative ATS predicted increased postoperative ATS, which was associated with residual postoperative knee instability after anatomical ACL reconstruction using bone‐patellar tendon‐bone and double‐bundle hamstrings tendon grafts with suspensory fixation. Level of Evidence Level IV, retrospective case series.
Murakami et al. (Sun,) studied this question.