KSSTA - 2026-09-21 - Journal Article
Anterior tibial translation in anterior cruciate ligament-deficient knees is increased regardless of tear location and independently associated with early-to-intermediate injury chronicity.
Hingsamer V, Arras C, Mueller MM, Nash G, DiFelice GS
Topics
Key Takeaway
After multivariable adjustment, ACL tear location (modified Sherman classification) does not independently predict anterior tibial translation side-to-side difference (ATT-SSD), but injury chronicity does (B = -0.205, p = 0.032), with acute injuries showing 0.6 mm greater ATT-SSD than chronic injuries (4.6 vs. 4.0 mm).
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Summary
This single-surgeon retrospective study asked whether ACL tear type (modified Sherman classification) and injury chronicity independently predict preoperative instrumented ATT-SSD measured by Lachmeter digital arthrometer in 521 patients undergoing primary ACL surgery. Unadjusted analyses showed Types III–V tears had 0.5 mm greater ATT-SSD than Type I (p=0.004) and acute injuries had greater ATT-SSD than subacute and chronic injuries (4.6 vs. 4.2 vs. 4.0 mm; p=0.005). On multivariable regression, only chronicity remained independently associated with ATT-SSD (B=-0.205, p=0.032); tear location was not, and all groups exceeded the 3 mm clinically meaningful threshold.
Key Limitation
Time-to-first-visit as the chronicity surrogate conflates healthcare access delays with true injury-to-instability progression, potentially misclassifying patients and attenuating the observed chronicity effect.
Original Abstract
PURPOSE
To determine whether anterior cruciate ligament (ACL) tear type and injury chronicity influence preoperative instrumented anterior tibial translation side-to-side difference (ATT-SSD) in patients undergoing primary ACL surgery, and, as a secondary aim, to evaluate the association between concomitant meniscal tears and ATT-SSD.
METHODS
This retrospective single-surgeon study included 521 patients who underwent surgery for ACL injury between October 2019 and January 2026. Preoperative ATT-SSD was measured using a Lachmeter® digital arthrometer, and ACL tears were classified arthroscopically according to the modified Sherman classification. Injuries were categorized by time to first visit as acute (<28 days), subacute (28-90 days) or chronic (>90 days). Associations between tear type, chronicity, meniscal repair and ATT-SSD were assessed using analysis of variance, subgroup comparisons, interaction analysis and multivariable linear regression.
RESULTS
ATT-SSD differed across tear-type groups (p = 0.006), with Types III-V tears demonstrating a 0.5-mm greater mean ATT-SSD than Type I tears (p = 0.004), while Type II tears did not differ significantly from either group. Acute injuries showed greater ATT-SSD than subacute and chronic injuries (4.6 ± 1.5 vs. 4.2 ± 1.5 and 4.0 ± 1.5 mm; p = 0.005). The tear type × chronicity interaction was not significant (B = 0.019, p = 0.951). ATT-SSD was higher in patients undergoing medial meniscus repair. In multivariable regression, only chronicity remained independently associated with ATT-SSD (B = -0.205, p = 0.032), whereas ACL tear location was not independently associated with ATT-SSD.
CONCLUSIONS
Mean ATT-SSD remained above the clinically meaningful threshold of ≥3 mm across all ACL tear types. Although small differences in ATT-SSD were observed according to tear location and early-to-intermediate injury chronicity in unadjusted analyses, only chronicity remained independently associated with ATT-SSD after adjustment. These findings suggest that ACL tear location alone should not be seen as a clinical predictor of anterior sagittal knee stability after ACL injury.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.