Graft remodelling of hamstring ACL graft and secondary meniscal lesions are affected by tibial slope and body mass index.

Purpose: The purpose of this study was to evaluate which factors are associated with the remodelling of an anterior cruciate ligament graft and secondary meniscal lesions. Methods: A retrospective longitudinal study was conducted to investigate the relationship between various factors and the occurrence of graft remodelling measured with the signal to noise quotient or the appearance of secondary meniscal lesion. Data were collected prospectively and analysed retrospectively for this study. The principal endpoint was the signal-to-noise quotient on MRI at 1 year postoperatively. The secondary endpoint was the appearance of 1-year secondary meniscal lesion on MRI only. The effect of the following parameters was investigated: gender, smoking status, age, body mass index, type of sport, preoperative meniscal lesion, lateral tibial slope measured on MRI, medial tibial slope measured on MRI and time from initial injury to surgery. Results: A total of 178 patients were enroled. The following factors were significantly and independently associated with the signal to noise quotient: body mass index > 25 kg/m2 (coefficient = 3.33 - p < 0.001) and lateral tibial slope ≥ 1.5° (Q2-3-4 vs. Q1 - coefficient = 2.24 - p = 0.015). Higher preoperative body mass index (24.70 ± 3.25 vs. 22.90 ± 3.14 - p = 0.034), medial tibial slope (odds ratio = 3.64 [95% confidence interval: 1.17-11.3] for Q3-4 vs. Q1-Q2 - p = 0.019) and lateral tibial slope (odds ratio = 4.04 [1.22-13.4] for Q3-4 vs. Q1-Q2 - p = 0.016) were significantly associated with the occurrence of secondary meniscal lesions on magnetic resonance imaging 1 year after surgery. Conclusion: Having a high body mass index and an increased lateral tibial slope were significantly and independently associated with poorer graft remodelling and may lead to secondary meniscal lesions. BMI and tibial slope are key clinical factors influencing graft healing and secondary meniscal lesions after ACL reconstruction. Level of Evidence: Level III.