The Effects of Surgical Parameters on Meniscal Mechanics Following Anterior Cruciate Ligament Reconstruction: An Exploratory In-Silico Study

The meniscus plays a vital role in knee biomechanics, contributing to shock absorption, joint stability, proprioception, and lubrication. Anterior cruciate ligament reconstruction (ACLR) aims to restore knee stability after anterior cruciate ligament (ACL) injury; however, 30–60% of patients experience concurrent or subsequent meniscal damage. Despite this, the influence of ACLR surgical parameters on meniscal biomechanics remains largely unexplored. This study investigates how four key ACLR surgical parameters—graft type, graft size, tunnel location, and pre-tensioning—affect meniscal contact forces and stress using a coupled neuromusculoskeletal-finite element (NMSKFE) modelling approach during simulated walking. NMSK-FE simulations were conducted in six participants to assess changes in meniscal-tibial contact forces and stress distributions under various ACLR configurations. While most surgical conditions restored meniscal mechanics to near-intact levels (normalized root mean square error (nRMSE) < 10%), substantial deviations were observed in certain cases, particularly in anteroposterior and mediolateral contact forces and maximum principal stress (nRMSE > 10%). Notably, posterior graft placement with zero pre-tensioning increased medial meniscus stress, potentially elevating the risk of degeneration or injury. These findings highlight the individualized nature of ACLR outcomes, influenced not only by surgical parameters but also by patient-specific factors such as knee morphology and gait patterns. This study underscores the need for pre-surgical assessments that integrate patient-specific biomechanics to optimize ACLR strategies, enhance meniscal preservation, and improve long-term knee health. By incorporating meniscal mechanics and dynamic gait analysis, this research advances personalized ACLR approaches, addressing a critical gap in the field. • Subject-specific joint geometry and control modulate post-ACLR meniscal mechanics. • ACLR parameter efficacy varied, underscoring the need for personalized protocols. • NMSK-FE modelling enables predictive, individualized ACLR surgical planning. • Posterior graft placement and low pre-tension elevated meniscal stress profiles.