Radiographic tibial tubercle morphology as a predictor of anterior cruciate ligament injury

PurposeFew studies have assessed the link between tibial tubercle (TT) morphology and anterior cruciate ligament (ACL) injury, and most focus only on the TT-trochlear groove (TT-TG) distance. This study aimed to examine the relationship between ACL injury, TT morphology, and posterior tibial slope (PTS) by comprehensively evaluating TT-related radiological parameters.MethodsRadiological images of 100 patients who underwent isolated ACL reconstruction for non-contact injury between 2016 and 2022 and 100 demographically matched controls with no relevant abnormalities on knee MRI were retrospectively analyzed. Thirteen radiological parameters were measured and compared, including PTS; TT torsion (TTT); TT-rotational angle (TT-RA); plateau axis-tuberosity axis (PA-TA); TT-TG; TT-PCL distance and ratio; TT lateralization (TTL) distance and ratio; TT height (TTH); and TT angle (TTA). Associations between these parameters and ACL injury, as well as interparameter correlations, were evaluated using t-tests, logistic regression, ROC analysis, and Pearson correlation.ResultsMean TTT, TT-RA and PA-TA values were significantly lower in the ACL injury group (5.68° vs 8.34°, p < .001; 7.96° vs 12.09°, p < .001; 8.41° vs 11.58°, p < .001). Conversely, TT-TG, PTS and TTH were higher (10.69 mm vs 8.17 mm, p < .001; 12.84° vs 10.61°, p < .001; 11.69 mm vs 10.02 mm, p < .001). Logistic regression showed TTT (OR = -0.849), TT-RA (OR = -0.822), TT-TG (OR = 1.298), PTS (OR = 1.177), and TTH (OR = 1.327) independently associated with ACL injury.ConclusionIn isolated ACL injury patients, TT torsion was lower and TT prominence higher. TT morphology assessment may help personalize ACL reconstruction, identify high-risk individuals, and support future clinical and biomechanical research on ACL injury susceptibility.