{"title":"Predictors of Tunnel Widening After Anterior Cruciate Ligament Reconstruction","authors":"Romir Patel, Maher Ghandour, Fabio Sammartino, Julien Druel, Drew Slater, Wiemi Douoguih, Matthieu Ollivier","doi":"10.1177/03635465251382911","DOIUrl":null,"url":null,"abstract":"Background: Posterior tibial slope (PTS) has been implicated in tunnel widening after anterior cruciate ligament reconstruction (ACLR), yet its precise effect remains unclear. Additionally, the influence of lateral extra-articular tenodesis (LET) and meniscus root injuries on tunnel widening has not been well established. Purpose: To evaluate the effect of medial and lateral PTS, LET, and meniscus root injuries on tibial and femoral tunnel widening after ACL reconstruction using a hamstring tendon graft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 307 patients who underwent primary ACLR with a hamstring tendon graft were included. Tibial and femoral tunnel diameters were measured immediately postoperatively and at 2-year follow-up. PTS was assessed by long lateral radiographs. Univariate and multivariate regression models were used to identify predictors of tunnel widening. Results: At 2 years, the mean ± Standard Deviation (SD) tibial tunnel diameter increased from 9.46 ± 1.00 mm postoperatively to 11.35 ± 1.55 mm ( <jats:italic>P</jats:italic> < .001), and the mean femoral tunnel diameter increased from 9.27 ± 0.83 mm to 11.52 ± 1.63 mm ( <jats:italic>P</jats:italic> < .001). Univariate analysis demonstrated that steeper medial and lateral PTS were significantly associated with tibial ( <jats:italic>P</jats:italic> < .0001) and femoral ( <jats:italic>P</jats:italic> < .0001) tunnel widening. Meniscus root injuries ( <jats:italic>P</jats:italic> = .0024) and higher body mass index ( <jats:italic>P</jats:italic> = .0127) were also associated with increased tunnel widening. In multivariate regression, medial PTS (β = −0.321; <jats:italic>P</jats:italic> < .0001), lateral PTS (β = −0.137; <jats:italic>P</jats:italic> = .0356), LET (β = 0.2207; <jats:italic>P</jats:italic> = .0257), and meniscus root injuries ( <jats:italic>P</jats:italic> = .0024) remained independent predictors of tunnel widening. Conclusion: Steeper medial and lateral PTSs, the addition of LET, and the presence of meniscus root injuries are significant independent predictors of tibial and femoral tunnel widening after ACLR with a hamstring graft. These findings highlight key anatomic and surgical factors influencing postoperative tunnel remodeling and emphasize the importance of considering these variables in ACLR planning.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":"3635465251382911"},"PeriodicalIF":0.0000,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The American Journal of Sports Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/03635465251382911","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Posterior tibial slope (PTS) has been implicated in tunnel widening after anterior cruciate ligament reconstruction (ACLR), yet its precise effect remains unclear. Additionally, the influence of lateral extra-articular tenodesis (LET) and meniscus root injuries on tunnel widening has not been well established. Purpose: To evaluate the effect of medial and lateral PTS, LET, and meniscus root injuries on tibial and femoral tunnel widening after ACL reconstruction using a hamstring tendon graft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 307 patients who underwent primary ACLR with a hamstring tendon graft were included. Tibial and femoral tunnel diameters were measured immediately postoperatively and at 2-year follow-up. PTS was assessed by long lateral radiographs. Univariate and multivariate regression models were used to identify predictors of tunnel widening. Results: At 2 years, the mean ± Standard Deviation (SD) tibial tunnel diameter increased from 9.46 ± 1.00 mm postoperatively to 11.35 ± 1.55 mm ( P < .001), and the mean femoral tunnel diameter increased from 9.27 ± 0.83 mm to 11.52 ± 1.63 mm ( P < .001). Univariate analysis demonstrated that steeper medial and lateral PTS were significantly associated with tibial ( P < .0001) and femoral ( P < .0001) tunnel widening. Meniscus root injuries ( P = .0024) and higher body mass index ( P = .0127) were also associated with increased tunnel widening. In multivariate regression, medial PTS (β = −0.321; P < .0001), lateral PTS (β = −0.137; P = .0356), LET (β = 0.2207; P = .0257), and meniscus root injuries ( P = .0024) remained independent predictors of tunnel widening. Conclusion: Steeper medial and lateral PTSs, the addition of LET, and the presence of meniscus root injuries are significant independent predictors of tibial and femoral tunnel widening after ACLR with a hamstring graft. These findings highlight key anatomic and surgical factors influencing postoperative tunnel remodeling and emphasize the importance of considering these variables in ACLR planning.