Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

20-09-2023 | KNEE

Bone morphology features associated with knee kinematics may not be predictive of ACL elongation during high-demand activities

Authors: Koji Nukuto, Tom Gale, Tetsuya Yamamoto, Volker Musahl, William Anderst

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2023

Abstract

Purpose

Bony morphology has been proposed as a potential risk factor for anterior cruciate ligament (ACL) injury. The relationship between bony morphology, knee kinematics, and ACL elongation during high-demand activities remains unclear. The purpose of this study was to determine if bone morphology features that have been associated with ACL injury risk and knee kinematics are also predictive of ACL elongation during fast running and double-legged drop jump.

Methods

Nineteen healthy athletes performed fast running and double-legged drop jump within a biplane radiography imaging system. Knee kinematics and ACL elongation were measured bilaterally after using a validated registration process to track bone motion in the radiographs and after identifying ACL attachment sites on magnetic resonance imaging (MRI). Bony morphological features of lateral posterior tibial slope (LPTS), medial tibial plateau (MTP) depth, and lateral femoral condyle anteroposterior width (LCAP)/lateral tibial plateau anteroposterior width (TPAP) were measured on MRI. Relationships between bony morphology and knee kinematics or ACL elongation were identified using multiple linear regression analysis.

Results

No associations between bony morphology and knee kinematics or ACL elongation were observed during fast running. During double-legged drop jump, a greater range of tibiofemoral rotation was associated with a steeper LPTS (β = 0.382, p = 0.012) and a deeper MTP depth (β = 0.331, p = 0.028), and a greater range of anterior tibial translation was associated with a shallower MTP depth (β = − 0.352, p = 0.018) and a larger LCAP/ TPAP (β = 0.441, p = 0.005); however, greater ACL elongation was only associated with a deeper MTP depth (β = 0.456, p = 0.006) at toe-off.

Conclusion

These findings indicate that observed relationships between bony morphology and kinematics should not be extrapolated to imply a relationship also exists between those bone morphology features and ACL elongation during high-demand activities. These new findings deepen our understanding of the relationship between bony morphology and ACL elongation during high-demand activities. This knowledge can help identify high-risk patients for whom additional procedures during ACL reconstruction are most appropriate.

Anderst W, Charles S, Zarei M, Mani A, Frankston N, Hammersley E et al (2022) Using Simultaneous Confidence Bands to Calculate the Margin of Error in Estimating Typical Biomechanical Waveforms. J Appl Biomech 38:232–236CrossRefPubMed

Anderst W, Zauel R, Bishop J, Demps E, Tashman S (2009) Validation of Three-Dimensional Model-Based Tibio-Femoral Tracking During Running. Med Eng Phys 31:10–16CrossRefPubMed

Araki D, Thorhauer E, Tashman S (2018) Three-Dimensional Isotropic Magnetic Resonance Imaging Can Provide A Reliable Estimate of The Native Anterior Cruciate Ligament Insertion Site Anatomy. Knee Surg Sports Traumatol Arthrosc 26:1311–1318CrossRefPubMed

Baek SY, Beaulieu ML, Wojtys EM, Ashton-Miller JA (2023) Relationship Between Lateral Tibial Posterior Slope and Tibiofemoral Kinematics During Simulated Jump Landings in Male Cadaveric Knees. Orthop J Sport Med 11:23259671231160212. https://doi.org/10.1177/23259671231160213CrossRef

Bargagliotti M, Formagnana M, Benazzo F, Bellemans J, Zero E, Zanon G et al (2020) The Role of the Posterolateral Tibial Slope in the Rotational Instability of the Knee in Patients Affected by a Complete Isolated Anterior Cruciate Ligament Injury : Its Value in the Decision-Making Process during the Anterolateral Ligament Reconstruction. Joints 7:78–83PubMedPubMedCentral

Bayer S, Meredith SJ, Wilson K, De Sa D, Pauyo T, Byrne K et al (2020) Knee Morphological Risk Factors for Anterior Cruciate Ligament Injury: A Systematic Review. J Bone Joint Surg 102:703–718CrossRef

Bowman EN, Limpisvasti O, Cole BJ, ElAttrache NS (2021) Anterior Cruciate Ligament Reconstruction Graft Preference Most Dependent on Patient Age: A Survey of United States Surgeons. Arthroscopy 37:1559–1566CrossRefPubMed

Duerr R, Ormseth B, Adelstein J, Garrone A, Dibartola A, Kaeding C et al (2023) Elevated Posterior Tibial Slope Is Associated With Anterior Cruciate Ligament Reconstruction Failures : A Systematic Review and Meta-analysis. Arthroscopy 39:1299–1309CrossRefPubMed

Englander A, Iii ELB, Smith WAR, Garrett WE, Spritzer CE, Defrate LE (2019) In Vivo Anterior Cruciate Ligament Deformation During a Single-Legged Jump Measured by Magnetic Resonance Imaging and High-Speed Biplanar Radiography. Am J Sport Med 47:47–49CrossRef

10.

Erdfelder E, Franz F, Buchner A (1996) GPOWER : A general power analysis program. Behav Reseach Methods, Instruments Comput 28:1–11. https://doi.org/10.3758/BF03203630CrossRef

11.

Fernandes MS, Pereira R, Andrade R (2017) Is the femoral lateral condyle ’ s bone morphology the trochlea of the ACL ? Knee Surg Sports Traumatol Arthrosc 25:207–214CrossRefPubMed

12.

Foody JN, Bradley PX, Spritzer CE, Wittstein JR, Defrate LE (2023) Elevated In Vivo ACL Strain Is Associated With a Straight Knee in Both the Sagittal and the Coronal Planes. Am J Sports Med 51:422–428CrossRefPubMed

13.

Freeman MAR, Pinskerova V (2005) The movement of the normal tibio-femoral joint. J Biomech 38:197–208CrossRefPubMed

14.

Gale T, Anderst W (2019) Asymmetry in Healthy Adult Knee Kinematics Revealed Through Biplane Radiography of the Full Gait Cycle. J Orthop Res 37:609–614CrossRefPubMed

15.

Gianotti SM, Marshall SW, Hume PA, Bunt L (2009) Incidence of anterior cruciate ligament injury and other knee ligament injuries: A national population-based study. J Sci Med Sport 12:622–627CrossRefPubMed

16.

Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: Application to the knee. J Biomech Eng J Biomech Eng 105:136–144CrossRefPubMed

17.

Hashemi J, Chandrashekar N, Mansouri H, Gill B, Slauterbeck JR, Schutt RC et al (2010) Shallow Medial Tibial Plateau and Steep Medial and Lateral Tibial Slopes New Risk Factors for Anterior Cruciate Ligament Injuries. Am J Sport Med 38:54–62CrossRef

18.

Hodel S, Postolka B, Flury A, Schütz P, Taylor WR, Vlachopoulos L et al (2022) Influence of Bone Morphology on In Vivo Tibio-Femoral Kinematics in Healthy Knees during Gait Activities. J Clin Med 11:5082. https://doi.org/10.3390/jcm11175082CrossRefPubMedPubMedCentral

19.

Iwahashi T, Shino K, Nakata K, Nakamura N, Yamada Y, Yoshikawa H et al (2008) Assessment of the ‘“ functional length ”’ of the three bundles of the anterior cruciate ligament. Knee Surgery, Sport Traumatol Arthrosc 16:167–174CrossRef

20.

Jagadeesh N, Paidipati R, Parameshwar A, Shivalingappa VM (2023) Correlation of tibial parameters like medial, lateral posterior tibial slope and medial plateau depth with ACL injuries: randomized control study. Eur J Orthop Surg Traumatol 33:1267–1274CrossRefPubMed

21.

Jordan SS, DeFrate LE, Kyung WN, Papannagari R, Gill TJ, Li G (2007) The in vivo kinematics of the anteromedial and posterolateral bundles of the anterior cruciate ligament during weightbearing knee flexion. Am J Sports Med 35:547–554CrossRefPubMed

22.

Kataoka K, Nagai K, Hoshino Y, Shimabukuro M, Nishida K, Kanzaki N et al (2022) Steeper lateral posterior tibial slope and greater lateral - medial slope asymmetry correlate with greater preoperative pivot - shift in anterior cruciate ligament injury. J Exp Orthop 9:117. https://doi.org/10.1186/s40634-022-00556-xCrossRefPubMedPubMedCentral

23.

Kikuchi N, Kanamori A, Kadone H, Kajiwara M, Okuno K, Hyodo K et al (2022) Relationship Between Posterior Tibial Slope and Lower Extremity Biomechanics During a Single-Leg Drop Landing Combined With a Cognitive Task in Athletes After ACL Reconstruction. Orthop J Sport Med 10:23259671221107932CrossRef

24.

Kızılgöz V, Sivrioğlu AK, Ulusoy GR, Aydın H, Karayol SS, Menderes U (2018) Analysis of the risk factors for anterior cruciate ligament injury: an investigation of structural tendencies. Clin Imaging 50:20–30CrossRefPubMed

25.

Li G, Defrate LE, Sun H, Gill TJ (2004) In Vivo Elongation of the Anterior Cruciate Ligament and Posterior Cruciate Ligament During Knee Flexion. Am J Sports Med 32:1415–1420CrossRefPubMed

26.

Meyer EG, Haut RC (2008) Anterior cruciate ligament injury induced by internal tibial torsion or tibiofemoral compression. J Biomech 41:3377–3383CrossRefPubMed

27.

Misir A, Sayer G, Uzun E, Guney B, Guney A (2022) Individual and Combined Anatomic Risk Factors for the Development of an Anterior Cruciate Ligament Rupture in Men: A Multiple Factor Analysis Case-Control Study. Am J Sports Med 50:433–440CrossRefPubMed

28.

Nagai K, Gale T, Chiba D, Su F, Fu FH, Anderst W (2019) The Complex Relationship Between In Vivo ACL Elongation and Knee Kinematics During Walking and Running. J Orthop Res 37:1920–1928CrossRefPubMedPubMedCentral

29.

Nishida K, Xu C, Gale T, Anderst W, Fu F (2022) Symmetry and sex differences in knee kinematics and ACL elongation in healthy collegiate athletes during high-impact activities revealed through dynamic biplane radiography. J Orthop Res 40:239–251CrossRefPubMed

30.

Okazaki Y, Furumatsu T, Kodama Y, Kamatsuki Y, Okazaki Y, Hiranaka T et al (2021) Steep posterior slope and shallow concave shape of the medial tibial plateau are risk factors for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 29:44–50CrossRefPubMed

31.

Polamalu SK, Musahl V, Debski RE (2022) Tibiofemoral bony morphology features associated with ACL injury and sex utilizing three-dimensional statistical shape modeling. J Orthop Res 40:87–94CrossRefPubMed

32.

Rahnemai-Azar AA, Abebe ES, Johnson P, Labrum J, Fu FH, Irrgang JJ et al (2017) Increased lateral tibial slope predicts high-grade rotatory knee laxity pre-operatively in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 25:1170–1176CrossRefPubMed

33.

Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull United States 86:420–428CrossRef

34.

Smith HC, Vacek P, Johnson RJ, Slauterbeck JR, Hashemi J, Shultz S et al (2012) Risk factors for anterior cruciate ligament injury: A review of the literature - part 1: Neuromuscular and anatomic risk. Sports Health 4:69–78CrossRefPubMedPubMedCentral

35.

Tanaka T, Gale T, Nishida K, Xu C, Fu F, Anderst W (2023) Posterior tibial slope and meniscal slope correlate with in vivo tibial internal rotation during running and drop jump. Knee Surg Sports Traumatol Arthrosc 31:2366–2373CrossRefPubMed

36.

Taylor KA, Cutcliffe HC, Queen RM, Utturkar GM, Spritzer CE, Garrett WE et al (2013) In vivo measurement of ACL length and relative strain during walking ACL footprint ACL footprint. J Biomech 46:478–483CrossRefPubMed

37.

Taylor KA, Terry ME, Utturkar GM, Spritzer CE, Queen RM, Irribarra LA et al (2011) Measurement of in vivo anterior cruciate ligament strain during dynamic jump landing. J Biomech 44:365–371CrossRefPubMed

38.

Vasta S, Andrade R, Pereira R, Bastos R, Battaglia AG, Papalia R et al (2018) Bone morphology and morphometry of the lateral femoral condyle is a risk factor for ACL injury. Knee Surgery, Sport Traumatol Arthrosc 26:2817–2825CrossRef

39.

Wahl CJ, Westermann RW, Blaisdell GY, Cizik AM (2012) An association of lateral knee sagittal anatomic factors with non-contact ACL injury: Sex or geometry? J Bone Jt Surg Am 94:217–226CrossRef

40.

Wu J, Hosseini A, Kozanek M, Gadikota HR, Gill TJ 4th, Li G (2010) Kinematics of the Anterior Cruciate Ligament During Gait. Am J Sports Med 38:1475–1482CrossRefPubMedPubMedCentral

41.

Xu C, Aloi N, Gale T, Nishida K, Fu F, Anderst W (2023) Symmetry in Knee Arthrokinematics in Healthy Collegiate Athletes During Fast Running and Drop Jump Revealed through Dynamic Biplane Radiography. Osteoarthr Cartil S1063–4584(23)00835-X.

42.

Ye Z, Xu J, Chen J, Qiao Y, Wu C, Xie G et al (2022) Steep lateral tibial slope measured on magnetic resonance imaging is the best radiological predictor of anterior cruciate ligament reconstruction failure. Knee Surg Sports Traumatol Arthrosc 30:3377–3385CrossRefPubMed

Title: Bone morphology features associated with knee kinematics may not be predictive of ACL elongation during high-demand activities
Authors: Koji Nukuto
Tom Gale
Tetsuya Yamamoto
Volker Musahl
William Anderst
Publication date: 20-09-2023
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07560-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bone morphology features associated with knee kinematics may not be predictive of ACL elongation during high-demand activities

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2023

BLU-DAT: a new reliable and accurate arthrometer for measuring anterior knee laxity

_Combining return to sport, psychological readiness, body mass, hamstring strength symmetry, and hamstring/quadriceps ratio increases the risk of a second anterior cruciate ligament injury

Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty

Freeze-dried noncoagulating platelet-derived factor concentrate is a safe and effective treatment for early knee osteoarthritis

Semitendinosus tendons are commonly contaminated with skin flora during graft harvest for anterior cruciate ligament reconstruction

The ALR-RSI score can be used to evaluate psychological readiness to return to sport after acute Achilles tendon tear