{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T11:35:41Z","timestamp":1781523341511,"version":"3.54.1"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Graft impingement is a critical cause of anterior cruciate ligament reconstruction (ACLR) failure. Identifying its contributing factors is essential for improving surgical outcomes. This retrospective study aimed to evaluate the incidence of graft impingement following ACLR using magnetic resonance imaging (MRI) and to investigate potential anatomical and surgical risk factors. The findings are intended to provide theoretical support for reducing impingement rates and enhancing functional recovery. We retrospectively reviewed clinical and MRI data of 122 patients (68 males and 54 females) who underwent ACLR at our institution from January 2015 to December 2023. MRI was used to identify graft impingement and to measure potential anatomical and surgical factors, including graft angle, posterior tibial slope, tibial intercondylar eminence angle, intercondylar notch width, notch height, and roof inclination, tibial tunnel position, preoperative and postoperative tibial displacement (measured as anterior tibial translation), and concomitant injuries. Patients were categorized based on the presence or absence of impingement. Univariate analysis was followed by multivariable logistic regression to identify independent risk factors. Graft impingement occurred in 65 patients (53.3% of cases). Multivariable logistic regression revealed that smaller graft angles (odds ratio [OR]\u2009=\u20090.930, 95% confidence interval [CI]: 0.873\u20130.991, p\u2009=\u20090.026), anterior\u2013inferior osteophytes of the intercondylar notch roof (OR\u2009=\u20093.620, 95% CI: 1.408\u20139.311, p\u2009=\u20090.008), bony abnormalities at the tibial tunnel inlet (OR\u2009=\u20093.814, 95% CI: 1.509\u20139.632, p\u2009=\u20090.005) and postoperative tibial displacement &gt;5\u2009mm (OR\u2009=\u20096.573, 95% CI: 1.120\u201338.582, p\u2009=\u20090.037) were independent risk factors for graft impingement. Graft impingement after ACLR is independently associated with reduced graft angle, anterior\u2013inferior osteophytes of the intercondylar notch, excessive postoperative tibial displacement, and bony protrusions at the tibial tunnel inlet. These findings emphasize the importance of accurate tunnel positioning and anatomical assessment during surgery to improve patient outcomes.<\/jats:p>","DOI":"10.1055\/a-2684-8287","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T23:08:53Z","timestamp":1756508933000},"page":"085-092","source":"Crossref","is-referenced-by-count":1,"title":["Graft Angle, Intercondylar Notch Osteophytes, and Tibial Tunnel Abnormalities Influence Graft Impingement After Anterior Cruciate Ligament Reconstruction: A Retrospective MRI-Based Study"],"prefix":"10.1055","volume":"39","author":[{"given":"Miao","family":"Wu","sequence":"additional","affiliation":[{"name":"Radiology Department, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zebin","family":"Yang","sequence":"additional","affiliation":[{"name":"Radiology Department, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieping","family":"Xu","sequence":"additional","affiliation":[{"name":"Radiology Department, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangfei","family":"Shan","sequence":"additional","affiliation":[{"name":"Radiology Department, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chijun","family":"Ma","sequence":"additional","affiliation":[{"name":"Radiology Department, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fenhua","family":"Zhao","sequence":"additional","affiliation":[{"name":"Radiology Department, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0461-950X","authenticated-orcid":false,"given":"Chunlong","family":"Fu","sequence":"additional","affiliation":[{"name":"Radiology Department, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1136\/bjsports-2019-100959","article-title":"Risk of knee osteoarthritis after different types of knee injuries in young adults: a population-based cohort study","volume":"54","author":"B Snoeker","year":"2020","journal-title":"Br J Sports Med"},{"issue":"19","key":"ref2","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.2106\/JBJS.L.01705","article-title":"Societal and economic impact of anterior cruciate ligament tears","volume":"95","author":"R C Mather III","year":"2013","journal-title":"J Bone Joint Surg Am"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1177\/0363546506286866","article-title":"Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005","volume":"34","author":"L Y Griffin","year":"2006","journal-title":"Am J Sports Med"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"586","DOI":"10.2106\/JBJS.16.01412","article-title":"The effect of an ACL reconstruction in controlling rotational knee stability in knees with intact and physiologic laxity of secondary restraints as defined by tibiofemoral compartment translations and graft forces","volume":"100","author":"F R Noyes","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"09","key":"ref5","first-page":"1047","article-title":"[Core techniques and adverse events in anterior cruciate ligament reconstruction using a new generation of artificial ligaments: the consensus of Chinese specialists based on a modified Delphi method (Part 2)]","volume":"36","author":"Chinese Specialist Consensus Group On New Generation Artificial Ligaments Used For Anterior Cruciate Ligament Reconstruction","year":"2022","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1177\/0363546515578836","article-title":"Risk factors and predictors of subsequent ACL injury in either knee after ACL reconstruction: prospective analysis of 2488 primary ACL reconstructions from the MOON cohort","volume":"43","author":"C C Kaeding","year":"2015","journal-title":"Am J Sports Med"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s001670000125","article-title":"Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results","volume":"8","author":"C Sommer","year":"2000","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.diii.2014.04.007","article-title":"Imaging ACL reconstructions and their complications","volume":"96","author":"P Kulczycka","year":"2015","journal-title":"Diagn Interv Imaging"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.amsu.2019.10.022","article-title":"Revision of failed-posterior cruciate ligament (PCL) reconstruction due to tibial tunnel misplacement: a case report","volume":"48","author":"A MT Lubis","year":"2019","journal-title":"Ann Med Surg (Lond)"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.knee.2022.01.001","article-title":"Quantifying graft impingement in anterior cruciate ligament reconstruction","volume":"34","author":"W T Wilson","year":"2022","journal-title":"Knee"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1007\/s00167-012-2014-6","article-title":"Graft impingement in anterior cruciate ligament reconstruction","volume":"21","author":"T Iriuchishima","year":"2013","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/j.mri.2004.08.007","article-title":"Anterior cruciate ligament graft impingement against the posterior cruciate ligament: diagnosis using MRI plus three-dimensional reconstruction software","volume":"22","author":"E Fujimoto","year":"2004","journal-title":"Magn Reson Imaging"},{"issue":"08","key":"ref13","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1177\/0363546510363461","article-title":"Impingement pressure in the anatomical and nonanatomical anterior cruciate ligament reconstruction: a cadaver study","volume":"38","author":"T Iriuchishima","year":"2010","journal-title":"Am J Sports Med"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1007\/s00167-011-1680-0","article-title":"PCL to graft impingement pressure after anatomical or non-anatomical single-bundle ACL reconstruction","volume":"20","author":"T Iriuchishima","year":"2012","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1053\/jars.2001.21821","article-title":"Reflex extension loss after anterior cruciate ligament reconstruction due to femoral \u201chigh noon\u201d graft placement","volume":"17","author":"M J Strobel","year":"2001","journal-title":"Arthroscopy"},{"issue":"09","key":"ref16","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1177\/0363546515589164","article-title":"Risk of anterior cruciate ligament fatigue failure is increased by limited internal femoral rotation during in vitro repeated pivot landings","volume":"43","author":"M L Beaulieu","year":"2015","journal-title":"Am J Sports Med"},{"issue":"09","key":"ref17","doi-asserted-by":"crossref","first-page":"2880","DOI":"10.1007\/s00167-020-06300-1","article-title":"The risk of graft impingement still exists in modern ACL surgery and correlates with degenerative MRI signal changes","volume":"29","author":"S Sch\u00fctzenberger","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"10","key":"ref18","doi-asserted-by":"crossref","first-page":"638","DOI":"10.5312\/wjo.v7.i10.638","article-title":"Magnetic resonance imaging after anterior cruciate ligament reconstruction: a practical guide","volume":"7","author":"A Grassi","year":"2016","journal-title":"World J Orthop"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/BF00496765","article-title":"Some characteristics of the C-wave of ERGs recorded by a pair of electrodes on the cornea and sclera","volume":"202","author":"Y Honda","year":"1977","journal-title":"Albrecht Von Graefes Arch Klin Exp Ophthalmol"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1007\/s00167-017-4646-z","article-title":"Preoperative magnetic resonance imaging predicts eligibility for arthroscopic primary anterior cruciate ligament repair","volume":"26","author":"J P van der List","year":"2018","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"10","key":"ref21","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1016\/j.arthro.2005.07.008","article-title":"Anterior tibial subluxation in anterior cruciate ligament-deficient knees: quantification using magnetic resonance imaging","volume":"21","author":"S Mishima","year":"2005","journal-title":"Arthroscopy"},{"issue":"01","key":"ref22","doi-asserted-by":"crossref","first-page":"10362","DOI":"10.1038\/s41598-022-14190-1","article-title":"Diagnostic advantage of thin slice 2D MRI and multiplanar reconstruction of the knee joint using deep learning based denoising approach","volume":"12","author":"T Kakigi","year":"2022","journal-title":"Sci Rep"},{"issue":"S 01","key":"ref23","first-page":"S57","article-title":"Anterior tibial translation sign: factors affecting interpretation of anterior cruciate ligament tear","volume":"98","author":"N Numkarunarunrote","year":"2015","journal-title":"J Med Assoc Thai"},{"issue":"12","key":"ref24","doi-asserted-by":"crossref","first-page":"2954","DOI":"10.1177\/0363546520949212","article-title":"Steep posterior tibial slope and excessive anterior tibial translation are predictive risk factors of primary anterior cruciate ligament reconstruction failure: a case-control study with prospectively collected data","volume":"48","author":"Q K Ni","year":"2020","journal-title":"Am J Sports Med"},{"issue":"14","key":"ref25","doi-asserted-by":"crossref","first-page":"3503","DOI":"10.1177\/0363546520966721","article-title":"Anterior cruciate ligament graft tunnel placement and graft angle are primary determinants of internal knee mechanics after reconstructive surgery","volume":"48","author":"M F Vignos","year":"2020","journal-title":"Am J Sports Med"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1177\/036354659202000222","article-title":"The effect of tibial attachment site on graft impingement in an anterior cruciate ligament reconstruction","volume":"20","author":"N C Yaru","year":"1992","journal-title":"Am J Sports Med"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1055\/s-0037-1605551","article-title":"Effects of notchplasty on anterior cruciate ligament reconstruction: a systematic review","volume":"5","author":"F Ranuccio","year":"2017","journal-title":"Joints"},{"issue":"12","key":"ref28","doi-asserted-by":"crossref","first-page":"e2783","DOI":"10.1016\/j.eats.2021.08.025","article-title":"Transtibial anterior cruciate ligament reconstruction: tips for a successful anatomic reconstruction","volume":"10","author":"B J Manderle","year":"2021","journal-title":"Arthrosc Tech"},{"issue":"03","key":"ref29","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1007\/s00167-014-3209-9","article-title":"Anatomic anterior cruciate ligament reconstruction: a changing paradigm","volume":"23","author":"F H Fu","year":"2015","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"10","key":"ref30","doi-asserted-by":"crossref","first-page":"4299","DOI":"10.1007\/s00167-023-07481-1","article-title":"Technology-assisted anterior cruciate ligament reconstruction improves tunnel placement but leads to no change in clinical outcomes: a systematic review and meta-analysis","volume":"31","author":"E Yavari","year":"2023","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"11","key":"ref31","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1177\/0363546507305678","article-title":"Differences in the placement of the tibial tunnel during reconstruction of the anterior cruciate ligament with and without computer-assisted navigation","volume":"35","author":"F Mauch","year":"2007","journal-title":"Am J Sports Med"},{"issue":"09","key":"ref32","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1177\/03635465211018859","article-title":"Increased posterior tibial slope is associated with greater risk of graft roof impingement after anatomic anterior cruciate ligament reconstruction","volume":"49","author":"G Y Song","year":"2021","journal-title":"Am J Sports Med"},{"issue":"03","key":"ref33","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1177\/0363546519900158","article-title":"Excessive preoperative anterior tibial subluxation in extension is associated with inferior knee stability after anatomic anterior cruciate ligament reconstruction","volume":"48","author":"G Y Song","year":"2020","journal-title":"Am J Sports Med"},{"issue":"14","key":"ref34","doi-asserted-by":"crossref","first-page":"3670","DOI":"10.1177\/03635465231209310","article-title":"The posterior tibial slope is not associated with graft failure and functional outcomes after anatomic primary isolated anterior cruciate ligament reconstruction","volume":"51","author":"M Hinz","year":"2023","journal-title":"Am J Sports Med"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"8698167","DOI":"10.1155\/2018\/8698167","article-title":"Intercondylar notch impingement of the anterior cruciate ligament: a cadaveric in vitro study using robots","volume":"2018","author":"R Wilson","year":"2018","journal-title":"J Healthc Eng"},{"issue":"02","key":"ref36","first-page":"81","article-title":"Intercondylar notch encroachment following anterior cruciate ligament reconstruction: a prospective study","volume":"11","author":"R T Bents","year":"1998","journal-title":"Am J Knee Surg"},{"issue":"01","key":"ref37","doi-asserted-by":"crossref","first-page":"217","DOI":"10.2214\/ajr.169.1.9207528","article-title":"MR imaging findings in anterior cruciate ligament reconstruction: evaluation of notchplasty","volume":"169","author":"D A May","year":"1997","journal-title":"AJR Am J Roentgenol"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2684-8287.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T23:30:54Z","timestamp":1768951854000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2684-8287"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":37,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,1,20]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2684-8287","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]}}}