Exploring the influence of coronal plane alignment on tibial cartilage stress and tibiofemoral kinematics after pediatric ACL reconstruction: a sequentially linked neuromusculoskeletal finite element pilot study

The biomechanical implications of coronal-plane alignment following paediatric anterior cruciate ligament reconstruction (ACLR) remain unclear. Five adolescents underwent gait analysis, magnetic resonance imaging, and electromyography-informed neuromusculoskeletal finite-element modelling 12 months post-ACLR. Subject-specific models incorporating measured hip–knee–ankle angle were compared with neutral alignment simulations under identical gait inputs. Coronal-plane alignment produced participant-specific differences in tibial cartilage stress magnitude, with stress patterns preserved (r ≥ 0.90). Tibiofemoral kinematics remained unchanged, without consistent relationships between alignment and medial–lateral stress distribution. These exploratory findings suggest limited biomechanical influence of coronal-plane alignment under prescribed gait conditions, warranting further investigation in larger cohorts.