2025 ISAKOS Biennial Congress ePoster
Influence of Preoperative Flatfoot Parameters on Anatomical Double-Bundle ACL Reconstruction Graft Failure in Teenagers.
Yuko Takeuchi, MD, Gifu JAPAN
Ryosuke Kawai, MD, Gifu, Gifu JAPAN
Hideki Hiraiwa, MD, PhD, Nagoya, Aichi JAPAN
Takashi Tsukahara, MD, PhD, Mizuho, Gifu JAPAN
Department of Orthopedic Surgery, Asahi University Hospital, gifu, JAPAN
FDA Status Cleared
Summary
Preoperative CP angle and LTM angle themselves do not significantly differ between successful and failed DB-ACLR, however, the affected-to-unaffected side ratio for the CP angle is notably higher in patients with DB-ACLR failure.
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Abstract
Purpose
This study investigates how preoperative flatfoot parameters may influence anatomical double-bundle anterior cruciate ligament reconstruction (DB-ACLR) graft failure in teenagers.
Methods
We conducted a retrospective review of teenage patients who underwent DB-ACLR at our institution between 2016 and 2022, with a minimum follow-up period of 24 months. Teenagers were included as individuals aged 15 to 19 years. Patients were divided into two groups: those who showed no evidence of graft failure after primary ACLR (control group) and those who experienced graft failure after the procedure (failed group). We measured the calcaneal pitch (CP) angle and lateral talo-1st metatarsal (LTM) angle in both feet using weight-bearing lateral radiographs, and calculated the ratio of the affected side to the unaffected side (affected-to-unaffected side ratio, %). We used the Mann-Whitney U test to compare groups, with statistical significance set at p < 0.05. Receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal cutoff for identifying an increased risk of DB-ACLR graft failure.
Results
Out of 143 patients (52 male, 91 female) who met the inclusion criteria, 130 patients (45 male, 85 female) were assigned to the control group, and 13 patients (7 male, 6 female) were assigned to the failed group. The median CP angle of the affected side was 18.4° [9.8° to 33.4°] in the control group and 19.0° [12.5° to 34.0°] in the failed group, with no significant differences observed. The median LTM angle of the affected side was 7.2° [0.1° to 22.8°] in the control group and 5.6° [1.7° to 13.6°] in the failed group, with no significant differences observed. However, the affected-to-unaffected side ratio for the CP angle was significantly higher in the failed group at 108% [77% to 125%], compared to 94% [67% to 140%] in the control group (p = 0.025). In contrast, the affected-to-unaffected side ratio for the LTM angle did not differ significantly between the control group (111% [20% to 261%]) and the failed group (91% [42% to 247%]) (p = 0.057). ROC curve analysis identified an affected-to-unaffected side ratio for the CP angle >98% as a threshold for increased DB-ACLR graft failure risk, with a sensitivity of 62% and specificity of 77%.
Conclusions
Our findings suggest that, although the preoperative CP angle and LTM angle do not significantly differ between these two groups, the ratio of the CP angle between the affected and unaffected sides is notably higher in patients who experienced graft failure. Specifically, a CP angle ratio greater than 98% is associated with an increased risk of graft failure, with a sensitivity of 62% and a specificity of 77%. These results suggest that a larger CP angle in the affected foot compared to the unaffected foot may serve as a predictor of DB-ACLR graft failure in teenagers, highlighting the need for further research to explore its potential role in preoperative assessment and surgical planning. Level of Evidence: Level III, retrospective prognostic trial.