Top

Journal of Children's Orthopaedics

Published in:

Open Access 01-04-2015 | Original Clinical Article

Knee morphometric risk factors for acute anterior cruciate ligament injury in skeletally immature patients

Authors: K. Aaron Shaw, Brian Dunoski, Neil Mardis, Donna Pacicca

Published in: Journal of Children's Orthopaedics | Issue 2/2015

Abstract

Study design

Retrospective, case–control.

Purpose

Knee morphometric risk factors for noncontact anterior cruciate ligament (ACL) injury have been a popular topic with skeletally mature patients. Little research has focused on the skeletally immature, with conflicting conclusions. This study performs a comprehensive analysis of identified parameters thought to predispose to ACL injury in a skeletally immature cohort.

Methods

A retrospective review of pediatric patients undergoing knee magnetic resonance imaging (MRI) was performed over a 4-year period. Inclusionary criteria included mid-substance ACL disruption, skeletal immaturity, noncontact injury, without associated ligamentous disruption, and no medical condition associated with ligamentous laxity. MRI studies were analyzed by a pediatric musculoskeletal radiologist, measuring identified bony parameters, and compared with an age-matched control group without ligamentous injury. Data were analyzed using unpaired t-tests and logistic regression.

Results

One hundred and twenty-eight patients sustained an ACL disruption, 39 met all inclusionary criteria (66 excluded for associated ligamentous disruption, 23 skeletally mature, three traumatic mechanisms, one with Marfan syndrome). When compared to an age-matched control cohort, the notch width index (NWI) was found to be significantly smaller in the ACL-injured group (p = 0.046). Subgroups analysis demonstrated significant differences in morphometric parameters between subjects with isolated ACL injuries and concomitant medial collateral ligament (MCL) strain.

Conclusions

The NWI was significantly smaller in the ACL injury group. Significant differences were noted between isolated ACL injuries and ACL injuries with an MCL strain. This study further highlights the need for incorporating associated injury patterns when investigating the influence of morphometric factors for ACL injury in the skeletally immature.

Level of evidence

Level III.

Palmer I (1938) On the injuries to the ligaments of the knee joint. A clinical study. Acta Chir Scand Suppl 53:1–28

Uhorchak JM, Scoville CR, Williams GN, Arciero RA, St Pierre P, Taylor DC (2003) Risk factors associated with noncontact injury of the anterior cruciate ligament: a prospective four-year evaluation of 859 West Point cadets. Am J Sports Med 31(6):831–842PubMed

Smith HC, Vacek P, Johnson RJ, Slauterbeck JR, Hashemi J, Shultz S, Beynnon BD (2012) Risk factors for anterior cruciate ligament injury: a review of the literature—part 1: neuromuscular and anatomic risk. Sports Health 4(1):69–78CrossRefPubMedCentralPubMed

Stijak L, Herzog RF, Schai P (2008) Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case–control study. Knee Surg Sports Traumatol Arthrosc 16(2):112–117CrossRefPubMed

Hashemi J, Chandrashekar N, Mansouri H, Gill B, Slauterbeck JR, Schutt RC Jr, Dabezies E, Beynnon BD (2010) Shallow medial tibial plateau and steep medial and lateral tibial slopes: new risk factors for anterior cruciate ligament injuries. Am J Sports Med 38(1):54–62CrossRefPubMed

Vyas S, van Eck CF, Vyas N, Fu FH, Otsuka NY (2011) Increased medial tibial slope in teenage pediatric population with open physes and anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 19(3):372–377CrossRefPubMedCentralPubMed

Park JS, Nam DC, Kim DH, Kim HK, Hwang SC (2012) Measurement of knee morphometrics using MRI: a comparative study between ACL-injured and non-injured knees. Knee Surg Relat Res 24(3):180–185CrossRefPubMedCentralPubMed

Vrooijink SHA, Wolters F, van Eck CF, Fu FH (2011) Measurements of knee morphometrics using MRI and arthroscopy: a comparative study between ACL-injured and non-injured subjects. Knee Surg Sports Traumatol Arthrosc 19(Suppl 1):S12–S16CrossRefPubMed

van Eck CF, Kopf S, van Dijk CN, Fu FH, Tashman S (2011) Comparison of 3-dimensional notch volume between subjects with and subjects without anterior cruciate ligament rupture. Arthroscopy 27(9):1235–1241CrossRefPubMed

10.

Hashemi J, Bhuyian A, Mansouri H, Slauterbeck J, Beynnon B (2013) ACL-injured subjects have a smaller tibial spine than uninjured controls and females have a smaller tibial spine than males. Orthopaedic Research Society Conference, San Antonio, Texas, poster no. 0892

11.

Domzalski M, Grzelak P, Gabos P (2010) Risk factors for anterior cruciate ligament injury in skeletally immature patients: analysis of intercondylar notch width using magnetic resonance imaging. Int Orthop 34(5):703–707CrossRefPubMedCentralPubMed

12.

Simon RA, Everhart JS, Nagaraja HN, Chaudhari AM (2010) A case–control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech 43(9):1702–1707CrossRefPubMedCentralPubMed

13.

Charlton WPH, St John TA, Ciccotti MG, Harrison N, Schweitzer M (2002) Differences in femoral notch anatomy between men and women: a magnetic resonance imaging study. Am J Sports Med 30(3):329–333PubMed

14.

Shelbourne KD, Davis TJ, Klootwyk TE (1998) The relationship between intercondylar notch width of the femur and the incidence of anterior cruciate ligament tears. A prospective study. Am J Sports Med 26(3):402–408PubMed

15.

Muneta T, Takakuda K, Yamamoto H (1997) Intercondylar notch width and its relation to the configuration and cross-sectional area of the anterior cruciate ligament. A cadaveric knee study. Am J Sports Med 25(1):69–72CrossRefPubMed

16.

Stijak L, Radonjić V, Nikolić V, Blagojević Z, Aksić M, Filipović B (2009) Correlation between the morphometric parameters of the anterior cruciate ligament and the intercondylar width: gender and age differences. Knee Surg Sports Traumatol Arthrosc 17(7):812–817CrossRefPubMed

17.

Arendt E, Dick R (1995) Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 23(6):694–701CrossRefPubMed

18.

Liu SH, al-Shaikh R, Panossian V, Yang RS, Nelson SD, Soleiman N, Finerman GA, Lane JM (1996) Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament. J Orthop Res 14(4):526–533CrossRefPubMed

19.

Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, Cugat R (2009) Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 17(7):705–729CrossRefPubMed

20.

Frank JS, Gambacorta PL (2013) Anterior cruciate ligament injuries in the skeletally immature athlete: diagnosis and management. J Am Acad Orthop Surg 21(2):78–87CrossRefPubMed

21.

Liu RW, Farrow LD, Messerschmitt PJ, Gilmore A, Goodfellow DB, Cooperman DR (2008) An anatomical study of the pediatric intercondylar notch. J Pediatr Orthop 28(2):177–183CrossRefPubMed

22.

Mosher TJ, Liu Y, Torok CM (2010) Functional cartilage MRI T2 mapping: evaluating the effect of age and training on knee cartilage response to running. Osteoarthritis Cartilage 18(3):358–364CrossRefPubMedCentralPubMed

23.

Subburaj K, Kumar D, Souza RB, Alizai H, Li X, Link TM, Majumdar S (2012) The acute effect of running on knee articular cartilage and meniscus magnetic resonance relaxation times in young healthy adults. Am J Sports Med 40(9):2134–2141CrossRefPubMedCentralPubMed

24.

Boyde A, Firth EC (2005) Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 8. Quantitative back-scattered electron scanning electron microscopy and confocal fluorescence microscopy of the epiphysis of the third metacarpal bone. N Z Vet J 53(2):123–132CrossRefPubMed

Title: Knee morphometric risk factors for acute anterior cruciate ligament injury in skeletally immature patients
Authors: K. Aaron Shaw
Brian Dunoski
Neil Mardis
Donna Pacicca
Publication date: 01-04-2015
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 2/2015
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-015-0652-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Knee morphometric risk factors for acute anterior cruciate ligament injury in skeletally immature patients

Abstract

Study design

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Study design

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 2/2015

A functional electrical stimulation system improves knee control in crouch gait

Reliability of radiographic measures in infants with clubfoot treated with the Ponseti method

Cannulated, locking blade plates for proximal femoral osteotomy in children and adolescents

Combined double tarsal wedge osteotomy and transcuneiform osteotomy for correction of resistant club foot deformity (the bean-shaped foot)

Adolescent hallux valgus: a systematic review of outcomes following surgery

The prognostic value of the head-shaft angle on hip displacement in children with cerebral palsy