Magnetic Resonance Imaging-based Intrinsic Anatomical Parameters as Predictors of Anterior Cruciate Ligament Injury and Graft Failure: A Comparative Case–control Study

CONTEXT: Anterior cruciate ligament (ACL) injuries are common knee injuries associated with significant morbidity and risk of long-term osteoarthritis. Despite advances in the reconstruction techniques, graft failure still remains a clinical challenge. Intrinsic anatomical factors measurable on magnetic resonance imaging (MRI) may predispose individuals to both primary ACL injury and reconstruction failure. AIMS: To evaluate MRI-derived anatomical risk factors - posterior tibial slope (PTS), tibial tubercle-trochlear groove (TT-TG) distance, and intercondylar notch morphology and width - in ACL injury and graft failure, compared with controls. SETTINGS AND DESIGN: Retrospective case-control study at a tertiary academic center in Western India. SUBJECTS AND METHODS: One hundred adults undergoing knee MRI were grouped as ACL tear (n = 40), graft failure (n = 20), and controls (n = 40). Measurements included PTS, TT-TG distance, and notch width index (NWI) with morphology. STATISTICAL ANALYSIS USED: Continuous variables were compared using the one-way analysis of variance. Categorical variables were compared using Chi-square/Fisher's exact test. RESULTS: PTS was higher in ACL injury and graft failure (11.78°, 13.95°) versus controls (10.74°). TT-TG distance was increased (15.34 mm, 15.40 mm vs. 12.44 mm). NWI was lower (0.184, 0.198 vs. 0.228). V-shaped notch was more frequent but not independently significant. CONCLUSIONS: Increased PTS, TT-TG distance, and reduced NWI are the significant risk factors for ACL injury and graft failure.