Higher MRI-derived lateral femoral condyle ratio is associated with concomitant meniscal tears in ACL rupture

This study investigated whether lateral femoral condyle morphology on preoperative magnetic resonance imaging (MRI), quantified by the lateral femoral condyle ratio (LFCR) and lateral femoral condyle index (LFCI), and routine clinical characteristics were associated with arthroscopically confirmed concomitant meniscal tears in patients with anterior cruciate ligament (ACL) rupture.. This retrospective cohort included adults who underwent ACLR for unilateral ACL rupture between April 2021 and November 2024. Inclusion criteria were (1) complete ACL rupture confirmed on preoperative MRI and arthroscopy, (2) preoperative knee MRI suitable for morphometric analysis, and (3) age ≥18 years. Exclusion criteria were prior surgery on the index knee, associated fractures or multiligament injuries, severe osteoarthritis, discoid lateral meniscus, inflammatory joint disease, or inadequate MRI quality. Meniscal status was confirmed arthroscopically. LFCR and LFCI were measured on preoperative 1.5-T MRI. A total of 100 patients were included; routine clinical characteristics (age, sex, injury mechanism, injured side, and time from injury to ACLR) did not differ between patients with and without concomitant meniscal tears (all p > 0.050). LFCR was higher in patients with meniscal tears (70.340 ± 2.980% vs 67.220 ± 3.140%; p < 0.001), whereas LFCI was similar between groups (71.900 ± 5.670% vs 71.850 ± 5.200%; p = 0.865). In multivariable analysis, LFCR independently predicted concomitant meniscal tears (adjusted OR 1.422 per 1% increase; 95% CI 1.206–1.676; p < 0.001), whereas LFCI did not (adjusted OR 0.935; 95% CI 0.850–1.029; p = 0.169). Patients with ACL rupture and a higher LFCR on preoperative MRI were more likely to have concomitant meniscal tears, whereas LFCI and routine clinical characteristics were not significantly associated.