Risk factors of anterolateral ligament injury following anterior cruciate ligament injury

Cai Yifan; Yan Zhenxing; Yan Pengan; Zhang Zheng; Teng Yuanjun; Geng Bin; Xia Yayi

doi:10.12307/2026.666

Abstract：BACKGROUND:Anterior cruciate ligament reconstruction is the standard treatment for anterior cruciate ligament injuries;however,residual rotational instability persists postoperatively.While combined anterolateral ligament reconstruction is increasingly advocated to address this issue,the etiological risk factors for concomitant anterolateral ligament injuries remain poorly defined,limiting early diagnosis,surgical decision-making,and prevention of secondary meniscal/ligamentous injuries. OBJECTIVE:To identify the risk factors for concomitant anterolateral ligament injuries in patients with anterior cruciate ligament injury. METHODS:This retrospective study analyzed 300 patients diagnosed arthroscopically with non-contact anterior cruciate ligament injuries(January 2023 to January 2024).Based on preoperative magnetic resonance imaging,41 patients with anterolateral ligament injuries were included as the injury group and 1:2 matched with 82 controls(no anterolateral ligament injury).Anatomical parameters were assessed via magnetic resonance imaging,including femoral notch width,bicondylar width,notch width index,medial tibial depth,static anterior tibial subluxation,lateral tibial slope,medial tibial slope,and meniscal/collateral ligament status.Multivariate logistic regression and simple effects analysis were used to evaluate risk factors and synergistic interactions. RESULTS AND CONCLUSION:Compared with the control group,the anterolateral ligament injury group exhibited significantly higher rates of lateral meniscal tears(P<0.001),greater static anterior tibial subluxation(P=0.009),and increased lateral tibial slope(P=0.042).Multivariate Logistic analysis confirmed lateral meniscal injury[odds ratio(OR)=7.36;95%confidence interval(CI):2.78-19.48;P<0.001),static anterior tibial subluxation(OR=1.16;95%CI:1.03-1.29;P=0.008),and lateral tibial slope(OR=1.13;95%CI:1.01-1.27;P=0.040)as independent risk factors.Simple effects analysis showed that a synergistic effect between lateral meniscal injury and lateral tibial slope was observed at 4°<lateral tibial slope≤10°(P=0.007)and lateral tibial slope>10°(P<0.001).To conclude,lateral meniscal injury,elevated lateral tibial slope,and static anterior tibial subluxation are independent risk factors for concomitant anterolateral ligament injuries in anterior cruciate ligament-deficient knees,with synergistic interactions between elevated lateral tibial slope and lateral meniscal injury.