ArticleJournal of experimental orthopaedics2026
Graft orientation using the over-the-top technique in anterior cruciate ligament reconstruction: Magnetic resonance imaging-based study.
Article in Journal of experimental orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Transtibial ACL reconstruction produces higher sagittal inclination angles than the native ACL: A systematic review and meta-analysis of MRI-based measurements in 2047 knees.Journal of experimental orthopaedics · 2026Article
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7 authors.
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Abstract
Purpose: To quantify sagittal and coronal inclination angles following over-the-top (OTT) anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI), to compare these measurements with the native ACL, and to evaluate graft alignment relative to the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) consensus. Methods: Thirty-five patients underwent single-bundle OTT ACL reconstruction combined with lateral plasty and underwent postoperative MRI evaluation at a minimum of 6 months. The reference group consisted of 28 patients with knee pain and an intact ACL on MRI. Sagittal and coronal inclination angles were measured using standardised tibial-axis-based MRI definitions. Measurements were performed independently by two examiners, and mean values were used for analysis. Group comparisons were conducted using independent-samples Results: OTT reconstruction demonstrated a mean sagittal inclination angle (SIA) of 53.2° ± 5.1° and a mean coronal inclination angle (CIA) of 71.3° ± 5.9°. Compared with the native ACL cohort, OTT reconstructions showed significantly greater sagittal (mean difference 3.6°, Conclusion: OTT ACL reconstruction produces graft inclination angles that differ significantly from native ACL orientation but frequently fall within consensus-recommended MRI thresholds for sagittal alignment. MRI-based inclination assessment provides objective structural characterisation of this technique and complements previously reported long-term clinical outcomes. However, these imaging findings do not establish full anatomic replication or clinical equivalence. Level of Evidence: Level IV, case series.
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