This PRISMA-compliant systematic review synthesizes 68 studies and 5,834 ACL-injured knees to identify which osseous knee morphological parameters increase primary ACL injury risk. It evaluates femoral, tibial, meniscal, and ACL-specific anatomical variables across Level II and III evidence. The central question: which anatomic measurements should guide individualized ACL reconstruction planning?
Every ACL reconstruction decision should factor in the patient's osseous anatomy, not just graft choice. This review establishes that at least six independent morphological risk factors predict primary ACL injury and graft failure.
When evaluating an ACL injury — especially a revision or contralateral injury. Measure tibial slope on the lateral radiograph and assess notch morphology on MRI. A slope >12° should prompt serious consideration of concomitant deflexion osteotomy; two clinical series cited in this paper show improved Lysholm scores and reduced pivot-shift grades when slope correction is added to revision reconstruction.
For notch stenosis, resist the temptation to notchplasty your way to a bigger graft. An A-shaped notch or width <17 mm should drive graft downsizing, not notch enlargement, which carries its own complication profile.
The key anatomic principle from this paper: sagittal plane geometry is what matters. Q angle, bicondylar width, and other coronal parameters are not reliable ACL injury predictors. Focus your preoperative assessment on tibial slope, notch shape, condylar offset, and native ACL size.
This PRISMA-compliant systematic review synthesizes 68 studies and 5,834 ACL-injured knees to identify which osseous knee morphological parameters increase primary ACL injury risk. It evaluates femoral, tibial, meniscal, and ACL-specific anatomical variables across Level II and III evidence. The central question: which anatomic measurements should guide individualized ACL reconstruction planning?
Every ACL reconstruction decision should factor in the patient's osseous anatomy, not just graft choice. This review establishes that at least six independent morphological risk factors predict primary ACL injury and graft failure.
When evaluating an ACL injury — especially a revision or contralateral injury. Measure tibial slope on the lateral radiograph and assess notch morphology on MRI. A slope >12° should prompt serious consideration of concomitant deflexion osteotomy; two clinical series cited in this paper show improved Lysholm scores and reduced pivot-shift grades when slope correction is added to revision reconstruction.
For notch stenosis, resist the temptation to notchplasty your way to a bigger graft. An A-shaped notch or width <17 mm should drive graft downsizing, not notch enlargement, which carries its own complication profile.
The key anatomic principle from this paper: sagittal plane geometry is what matters. Q angle, bicondylar width, and other coronal parameters are not reliable ACL injury predictors. Focus your preoperative assessment on tibial slope, notch shape, condylar offset, and native ACL size.