Purpose
To provide a comprehensive summary of the available literature on the influence of
bone morphology on outcomes after anterior cruciate ligament reconstruction (ACLR).
Methods
Our protocol was prospectively registered with PROSPERO (International Prospective
Register of Systematic Reviews) and followed PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-analyses) guidelines. The PubMed, Embase, and MEDLINE
databases were searched for studies investigating knee morphologic features and outcomes
after ACLR. Articles were screened and references lists were reviewed to identify
relevant studies, after which methodologic quality was assessed for each study included
in this review. Because of significant variability in terminology and methodology
between studies, no meta-analyses were conducted.
Results
Systematically screening a total of 19,647 studies identified from the search revealed
24 studies that met the inclusion and exclusion criteria. Among tibial shape features
identified as predictors of poor outcomes after ACLR, increased posterior tibial slope
was most common (16 studies). Other features such as increased tibial plateau area
(1 study), decreased medial plateau width (1 study), and increased medial plateau
height (1 study) were also associated with poor outcomes. For the femur, features
related to notch width and condylar morphology were most common (4 studies and 7 studies,
respectively). An increased condylar offset ratio, increased lateral femoral condylar
ratio, and larger notch width were each found to be associated with negative ACLR
outcomes, including increased cartilage degeneration, worse patient-reported outcomes,
and graft failure.
Conclusions
Posterior tibial slope, notch width, condylar morphology, trochlear inclination, and
tibiofemoral mismatch are associated with and predictive of outcomes after ACLR.
Level of Evidence
Level IV, systematic review of Level II-IV studies.
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Article info
Publication history
Published online: December 15, 2021
Accepted:
November 30,
2021
Received:
June 24,
2021
Footnotes
D.N.B. and J.F.O. contributed equally to this work.
The authors report the following potential conflicts of interest or sources of funding: C.B.M. receives grants from Samumed and Aesculap and personal fees from Stryker and Slack, outside the submitted work. D.A.L. receives grants from Vericel, personal fees from Vericel, and educational support from Arthrex/Evolution Surgical, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2021 by the Arthroscopy Association of North America
