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Combined anatomic factors predicting risk of anterior cruciate ligament injury for males and females.

ABSTRACT: BACKGROUND:Knee joint geometry has been associated with risk of suffering an anterior cruciate ligament (ACL) injury; however, few studies have utilized multivariate analysis to investigate how different aspects of knee joint geometry combine to influence ACL injury risk. HYPOTHESES:Combinations of knee geometry measurements are more highly associated with the risk of suffering a noncontact ACL injury than individual measurements, and the most predictive combinations of measurements are different for males and females. STUDY DESIGN:Case-control study; Level of evidence, 3. METHODS:A total of 88 first-time, noncontact, grade III ACL-injured subjects and 88 uninjured matched-control subjects were recruited, and magnetic resonance imaging data were acquired. The geometry of the tibial plateau subchondral bone, articular cartilage, and meniscus; geometry of the tibial spines; and size of the femoral intercondylar notch and ACL were measured. Multivariate conditional logistic regression was used to develop risk models for ACL injury in females and males separately. RESULTS:For females, the best fitting model included width of the femoral notch at its anterior outlet and the posterior-inferior-directed slope of the lateral compartment articular cartilage surface, where a millimeter decrease in notch width and a degree increase in slope were independently associated with a 50% and 32% increase in risk of ACL injury, respectively. For males, a model that included ACL volume and the lateral compartment posterior meniscus to subchondral bone wedge angle was most highly associated with risk of ACL injury, where a 0.1 cm3 decrease in ACL volume (approximately 8% of the mean value) and a degree decrease in meniscus wedge angle were independently associated with a 43% and 23% increase in risk, correspondingly. CONCLUSION:Combinations of knee joint geometry measurements provided more information about the risk of noncontact ACL injury than individual measures, and the aspects of geometry that best explained the relationship between knee geometry and the risk of injury were different between males and females. Consequently, a female with both a decreased femoral notch width and an increased posterior-inferior-directed lateral compartment tibial articular cartilage slope combined or a male with a decreased ACL volume and decreased lateral compartment posterior meniscus angle were most at risk for sustaining an ACL injury.

SUBMITTER: Sturnick DR

PROVIDER: S-EPMC6607022 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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Combined anatomic factors predicting risk of anterior cruciate ligament injury for males and females.

Sturnick Daniel R DR Vacek Pamela M PM DeSarno Michael J MJ Gardner-Morse Mack G MG Tourville Timothy W TW Slauterbeck James R JR Johnson Robert J RJ Shultz Sandra J SJ Beynnon Bruce D BD

The American journal of sports medicine 20150112 4

<h4>Background</h4>Knee joint geometry has been associated with risk of suffering an anterior cruciate ligament (ACL) injury; however, few studies have utilized multivariate analysis to investigate how different aspects of knee joint geometry combine to influence ACL injury risk.<h4>Hypotheses</h4>Combinations of knee geometry measurements are more highly associated with the risk of suffering a noncontact ACL injury than individual measurements, and the most predictive combinations of measuremen ...[more]

PMID: 25583759

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Project description:The mechanisms of noncontact anterior cruciate ligament injury remain undefined. The purpose of this study was to identify the tibiofemoral alignment in the lateral compartment of the knee for three variations of a one-limb landing in noncontact sports activities: the safe, provocative, and exaggerated provocative positions. These positions were chosen on the basis of a previous study that measured the average joint angles of the limb at the point of ground contact for athletes who landed without injury (safe) and those who sustained an anterior cruciate ligament injury (provocative). It was hypothesized that, in the provocative positions, altered tibiofemoral alignment predisposes the knee to possible subluxation, potentially leading to an anterior cruciate ligament injury.Magnetic resonance images were acquired for a single knee in twenty-five noninjured athletes for the three landing positions. The angle between the posterior tibial slope and the femur along with three distances (from the tibiofemoral point of contact to [1] the femoral sulcus point, [2] the posterior tibial point, and [3] the most anterior point of the circular posterior aspect of the condyle) were measured for each acquisition.The tibial slope relative to the femur was directed significantly more inferior to superior in the provocative and exaggerated positions than in the safe landing position. Similarly, as the limb transitioned from the safe to the provocative positions, the tibiofemoral joint contact point was significantly closer to the femoral sulcus point and to the most anterior point of the circular posterior portion of the lateral femoral condyle.As the limb moves toward the provocative landing position, the anatomical alignment based on slope and contact characteristics places the knee at possible risk for noncontact anterior cruciate ligament injury. An enhanced understanding of the mechanism of anterior cruciate ligament injury may lead to improved preventative strategies.

Dataset Information

Combined anatomic factors predicting risk of anterior cruciate ligament injury for males and females.

Publications

Combined anatomic factors predicting risk of anterior cruciate ligament injury for males and females.

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