Preoperative dynamic anterior tibial translation is not predictive of graft rupture after anterior cruciate ligament reconstruction

Abstract Purpose This study aimed to determine whether higher preoperative dynamic anterior tibial translation (DATT) using laximetry is a risk factor for graft rupture after anterior cruciate ligament reconstruction (ACLR). Methods This retrospective study included all patients who underwent primary ACLR with hamstring autograft between January 2014 and December 2017. Demographic data, absolute DATT on the injured side and ΔDATT (side‐to‐side difference), posterior tibial slope (PTS), static anterior tibial translation (SATT), concomitant lateral extra‐articular tenodesis (LET) and meniscal tears were collected. Subgroup analysis was performed using a ΔDATT threshold of 6 mm. Univariate and multivariable logistic regression analyses were conducted to identify independent risk factors for ACL graft rupture. Results Among the 680 patients included with a minimum follow‐up of 6 years, 41 (6%) experienced graft rupture at a mean of 45 ± 30 months postoperatively. The median DATT on the injured side was 9 mm interquartile range, IQR, 5, and the median ΔDATT was 6 mm IQR, 4. Graft rupture occurred in 5.8% for patients with ΔDATT < 6 mm and in 6.3% for patients with ΔDATT ≥ 6 mm ( p = 0.787). Patients with ΔDATT ≥ 6 mm demonstrated a higher prevalence of medial meniscal tears (31% vs. 24%, p = 0.026). Independent risk factors for graft rupture included PTS ≥ 12° (odds ratio OR 3.1; 95% confidence interval CI, 1.6–6.3; p < 0.001) and SATT ≥ 5 mm (OR 2.6; 95% CI, 1.2–5.5; p = 0.027), whereas neither ΔDATT nor absolute DATT was significantly associated with graft rupture. Conclusion Preoperative DATT is not predictive of graft rupture following ACLR using hamstring autograft. PTS and SATT remain stronger predictors and should be prioritised for preoperative risk stratification. Level of Evidence Level III, retrospective case‐control study.