{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T10:07:08Z","timestamp":1779271628804,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"13","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Posterior tibial slope (PTS) has been implicated in tunnel widening after anterior cruciate ligament reconstruction (ACLR), yet its precise effect remains unclear. Additionally, the influence of lateral extra-articular tenodesis (LET) and meniscus root injuries on tunnel widening has not been well established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate the effect of medial and lateral PTS, LET, and meniscus root injuries on tibial and femoral tunnel widening after ACL reconstruction using a hamstring tendon graft.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 307 patients who underwent primary ACLR with a hamstring tendon graft were included. Tibial and femoral tunnel diameters were measured immediately postoperatively and at 2-year follow-up. PTS was assessed by long lateral radiographs. Univariate and multivariate regression models were used to identify predictors of tunnel widening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      At 2 years, the mean \u00b1 Standard Deviation (SD) tibial tunnel diameter increased from 9.46 \u00b1 1.00 mm postoperatively to 11.35 \u00b1 1.55 mm (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), and the mean femoral tunnel diameter increased from 9.27 \u00b1 0.83 mm to 11.52 \u00b1 1.63 mm (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Univariate analysis demonstrated that steeper medial and lateral PTS were significantly associated with tibial (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .0001) and femoral (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .0001) tunnel widening. Meniscus root injuries (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0024) and higher body mass index (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0127) were also associated with increased tunnel widening. In multivariate regression, medial PTS (\u03b2 = \u22120.321;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .0001), lateral PTS (\u03b2 = \u22120.137;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0356), LET (\u03b2 = 0.2207;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0257), and meniscus root injuries (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .0024) remained independent predictors of tunnel widening.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Steeper medial and lateral PTSs, the addition of LET, and the presence of meniscus root injuries are significant independent predictors of tibial and femoral tunnel widening after ACLR with a hamstring graft. These findings highlight key anatomic and surgical factors influencing postoperative tunnel remodeling and emphasize the importance of considering these variables in ACLR planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465251382911","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T05:37:11Z","timestamp":1759988231000},"page":"3108-3115","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of Tunnel Widening After Anterior Cruciate Ligament Reconstruction"],"prefix":"10.1177","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9813-4407","authenticated-orcid":false,"given":"Romir","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Sainte-Marguerite Hospital, Institute for Locomotion, Aix-Marseille University, Assistance Publique Hopitaux de Marseille (AP-HM), Centre National de la Recherche Scientifique (CNRS), Institut des Sciences du Mouvement (ISM), Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maher","family":"Ghandour","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Sainte-Marguerite Hospital, Institute for Locomotion, Aix-Marseille University, Assistance Publique Hopitaux de Marseille (AP-HM), Centre National de la Recherche Scientifique (CNRS), Institut des Sciences du Mouvement (ISM), Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Sammartino","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Sainte-Marguerite Hospital, Institute for Locomotion, Aix-Marseille University, Assistance Publique Hopitaux de Marseille (AP-HM), Centre National de la Recherche Scientifique (CNRS), Institut des Sciences du Mouvement (ISM), Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julien","family":"Druel","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Sainte-Marguerite Hospital, Institute for Locomotion, Aix-Marseille University, Assistance Publique Hopitaux de Marseille (AP-HM), Centre National de la Recherche Scientifique (CNRS), Institut des Sciences du Mouvement (ISM), Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Drew","family":"Slater","sequence":"additional","affiliation":[{"name":"MedStar Lafayette Orthopaedic and Sports Medicine Center, MedStar Washington Hospital Center, Washington, DC, USA"},{"name":"Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wiemi","family":"Douoguih","sequence":"additional","affiliation":[{"name":"MedStar Lafayette Orthopaedic and Sports Medicine Center, MedStar 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