Chinese Journal of Tissue Engineering Research ›› 2026, Vol. 30 ›› Issue (12): 2986-2993.doi: 10.12307/2026.666

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Risk factors of anterolateral ligament injury following anterior cruciate ligament injury

Cai Yifan1, Yan Zhenxing1, Yan Pengan1, Zhang Zheng1, Teng Yuanjun1, 2, 3, Geng Bin1, 2, 3, Xia Yayi1, 2, 3   

  1. 1Department of Orthopedics, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China; 2Orthopaedic Clinical Research Center of Gansu Province, Lanzhou 730030, Gansu Province, China; 3Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou 730030, Gansu Province, China
  • Received:2025-03-14 Accepted:2025-08-16 Online:2026-04-28 Published:2025-09-28
  • Contact: Xia Yayi, MD, Professor, Chief physician, Doctoral supervisor, Department of Orthopedics, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China; Orthopaedic Clinical Research Center of Gansu Province, Lanzhou 730030, Gansu Province, China; Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou 730030, Gansu Province, China
  • About author:Cai Yifan, MS candidate, Department of Orthopedics, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China
  • Supported by:
    National Natural Science Foundation of China, Nos. 81960403 (to GB), 82360436 (to XYY), and 82060405 (to XYY)

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Abstract: BACKGROUND: Anterior cruciate ligament reconstruction is the standard treatment for anterior cruciate ligament injuries; however, residual rotational instability persists postoperatively. While combined anterolateral ligament reconstruction is increasingly advocated to address this issue, the etiological risk factors for concomitant anterolateral ligament injuries remain poorly defined, limiting early diagnosis, surgical decision-making, and prevention of secondary meniscal/ligamentous injuries.
OBJECTIVE: To identify the risk factors for concomitant anterolateral ligament injuries in patients with anterior cruciate ligament injury.
METHODS: This retrospective study analyzed 300 patients diagnosed arthroscopically with non-contact anterior cruciate ligament injuries (January 2023 to January 2024). Based on preoperative magnetic resonance imaging, 41 patients with anterolateral ligament injuries were included as the injury group and 1:2 matched with 82 controls (no anterolateral ligament injury). Anatomical parameters were assessed via magnetic resonance imaging, including femoral notch width, bicondylar width, notch width index, medial tibial depth, static anterior tibial subluxation, lateral tibial slope, medial tibial slope, and meniscal/collateral ligament status. Multivariate logistic regression and simple effects analysis were used to evaluate risk factors and synergistic interactions.
RESULTS AND CONCLUSION: Compared with the control group, the anterolateral ligament injury group exhibited significantly higher rates of lateral meniscal tears (P < 0.001), greater static anterior tibial subluxation (P=0.009), and increased lateral tibial slope (P=0.042). Multivariate Logistic analysis confirmed lateral meniscal injury [odds ratio (OR)=7.36; 95% confidence interval (CI): 2.78–19.48; P < 0.001), static anterior tibial subluxation (OR=1.16; 95% CI: 1.03–1.29; P=0.008), and lateral tibial slope (OR=1.13; 95% CI: 1.01–1.27; P=0.040) as independent risk factors. Simple effects analysis showed that a synergistic effect between lateral meniscal injury and lateral tibial slope was observed at 4° < lateral tibial slope ≤ 10° (P=0.007) and lateral tibial slope > 10° (P < 0.001). To conclude, lateral meniscal injury, elevated lateral tibial slope, and static anterior tibial subluxation are independent risk factors for concomitant anterolateral ligament injuries in anterior cruciate ligament-deficient knees, with synergistic interactions between elevated lateral tibial slope and lateral meniscal injury. 

Key words: anterior cruciate ligament injury, anterolateral ligament injury, lateral meniscus, lateral tibial slope, static anterior tibial subluxation, synergistic effect 

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