Increased anterior tibial subluxation and differences between anterior tibial subluxation in the lateral and medial compartments are associated with failure of primary anterior cruciate ligament reconstruction: A systematic review and meta-analysis.

ABSTRACT

PURPOSE: The purpose of this study is to investigate whether increased anterior tibial subluxation (ATS) and differences between ATS in the lateral and medial compartments (ATSL-M) are associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure. METHODS: PubMed, Scopus, Embase and Web of Science were systematically searched from their inception through 21 November 2023. The focus was on comparative studies reporting ATS in patients who experienced primary ACLR failure, in contrast to patients after primary ACLR with no evidence of graft failure. A random-effects model was employed to calculate the overall standardized mean difference between the two groups. RESULTS: A total of eight studies involving 963 patients were included in the final review. Three studies (64 cases and 171 controls) measured ATS on radiographs. The failed ACLR group exhibited a significantly increased ATS on radiographs compared to the control group (p < 0.001). Six studies (324 cases and 488 controls) measured lateral ATS on magnetic resonance imaging and five of them (285 cases and 374 controls) also measured medial ATS. The average values of lateral and medial ATS, as well as ATSL-M, were calculated and compared between the two groups. The failed ACLR group demonstrated significantly increased lateral (p < 0.001) and medial ATS (p < 0.001), the average value of lateral and medial ATS (p < 0.001) and ATSL-M (p = 0.039) compared to the control group. CONCLUSION: Increased ATS and ATSL-M are associated with primary ACLR failure. The measurement of tibiofemoral position shows promise for its application in preoperative planning and postoperative management of ACLR. LEVEL OF EVIDENCE Level III.