Anterior tibial translation in anterior cruciate ligament‐deficient knees is increased regardless of tear location and independently associated with early‐to‐intermediate injury chronicity

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.