Lateral Tibial Slope on Pre-Reconstruction MRI in ACL Graft Rerupture: Association, Discriminative Performance, and Measurement Reliability

Background/Objectives: This study evaluated the association between lateral tibial slope (LTS), measured using the Hudek method on magnetic resonance imaging (MRI) before primary anterior cruciate ligament (ACL) reconstruction, and ACL graft rerupture, and assessed the discriminative performance and reliability.

Methods

This retrospective comparative study included 23 patients with definite ACL graft rerupture and 46 controls without rerupture after at least two years of follow-up. LTS was independently measured twice, four weeks apart, by a radiologist and an orthopedic surgeon blinded to group allocation and clinical outcomes. Reliability was assessed using intraclass correlation coefficients (ICCs), interobserver agreement using Bland–Altman analysis, and discriminative performance using receiver operating characteristic (ROC) analysis. Age-adjusted associations with rerupture were evaluated using logistic regression.