Age‐related changes in ACL morphology during skeletal growth and maturation are different between females and males

Hosseinzadeh, Shayan; Kiapour, A. M.

doi:10.1002/jor.24748

Cited by 35 publications

(68 citation statements)

References 46 publications

(89 reference statements)

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“…These studies have also found that while ACL length and CSA are similar between the sexes during childhood, both measurements are 15-25% larger in males during late adolescence. [6][7][8] Similarly, our findings showed that ACL length and CSA were 15% and 23% larger, respectively, in males than females during late adolescence. Additionally, in agreement with the current study, human studies found little to no (0-3°) impact of sex on ACL inclination angle.…”

Section: Discussionsupporting

confidence: 71%

“…The changes in ACL morphology with respect to growth and sex from our study are also consistent with skeletally immature human data. Studies have shown approximately two-fold increases in ACL length and CSA, [6][7][8] and approximately 15° increases in angular inclination 8; 33 from early youth to late adolescence. These studies have also found that while ACL length and CSA are similar between the sexes during childhood, both measurements are 15-25% larger in males during late adolescence.…”

Section: Discussionmentioning

confidence: 99%

“…The ACL is similar in size between males and females during childhood, but becomes larger in length and cross-sectional area (CSA) in males after the onset of adolescence. [5][6][7][8] Additionally, anterior-posterior (AP) knee laxity decreases throughout skeletal growth with similar values between males and females during childhood. [9][10][11] During adolescence [9][10][11] and adulthood, 12 AP knee laxity appears greater in females than males.…”

Section: Introductionmentioning

confidence: 99%

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Sex-Specific Function and Morphology of the Anterior Cruciate Ligament During Skeletal Growth in a Porcine Model

Howe

Cone

Piedrahita

et al. 2021

Preprint

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Pediatric anterior cruciate ligament (ACL) injuries are on the rise, and females experience higher ACL injury risk than males during adolescence. Studies in skeletally immature patients indicate differences in ACL size and joint laxity between males and females after the onset of adolescence. However, functional data regarding the ACL and its anteromedial and posterolateral bundles in the pediatric population remain rare. Therefore, this study uses a porcine model to investigate the sex-specific morphology and function of the ACL and its bundles throughout skeletal growth. Hind limbs from male and female Yorkshire pigs aged early youth to late adolescence were imaged using magnetic resonance imaging to measure the size and orientation of the ACL and its bundles, then biomechanically tested under anterior-posterior drawer using a robotic testing system. Joint laxity decreased (p<0.001) while joint stiffness increased (p<0.001) throughout skeletal growth in both sexes. The ACL was the primary stabilizer against anterior tibial loading in all specimens, while the functional role of the anteromedial bundle increased with age (p<0.001), with an earlier shift in males. ACL and posterolateral bundle cross-sectional area and ACL and anteromedial bundle length were larger in males than females during adolescence (p<0.01 for all), while ACL and bundle sagittal angle remained similar between sexes. Additionally, in situ ACL stiffness correlated with cross-sectional area across skeletal growth (r2=0.75, p<0.001 in males and r2=0.64, p<0.001 in females), but not within age groups. This study has implications for age and sex-specific surgical intervention strategies and suggests the need for human studies.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sex-Specific Function and Morphology of the Anterior Cruciate Ligament During Skeletal Growth in a Porcine Model

Howe

Cone

Piedrahita

et al. 2021

Preprint

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“…Second, the age in the ACLD group was greater than the ACLI group, so that a confounding factor might have been brought in this case-control study. However, the age difference could be explained by the strong association between the grade of ACL degeneration and the grade of knee osteoarthritis [ 22 ], where a greater age is related to a greater degeneration of the knee [ 23 , 24 ]. Third, the slice thickness of the MRI was 4 mm, which could create bias in PATS measurements.…”

Section: Discussionmentioning

confidence: 99%

Value of passive anterior tibial subluxation on axial MRI in identifying anterior cruciate ligament functional deficiency in patients with advanced anteromedial osteoarthritis of the knee: a case-control study

Tao

Tang

Zhao

et al. 2021

BMC Musculoskelet Disord

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Background A functionally deficient anterior cruciate ligament (ACL) is considered one of the contraindications in unicompartmental knee arthroplasty (UKA). But there is still a lack of standardized and reproducible methods to assess ACL functional integrity in patients with advanced anteromedial osteoarthritis of the knee (AMOA). This study explores the value of passive anterior tibial subluxation (PATS) on axial MRI in evaluating ACL status in this population. Methods Patients who met UKA indications between November 2017 and September 2020 were included and grouped into “intact” (ACLI) or “deficient” (ACLD) group according to their ACL status during surgery. All participants underwent MRI with a standardized protocol. The measurements of medial and lateral PATS were conducted on axial MRI, and the mean of them was calculated as global PATS. Then the reliability and diagnostic ability of PATS were determined. Results A total of 85 patients (45 for ACLI group, 40 for ACLD group) were included after selection. The measurements of PATS showed excellent intra- and inter-observer reliabilities (with an intraclass correlation coefficient of at least 0.986). The global PATS of the ACLI group was significantly lower than that of the ACLD group (− 2.30 ± 1.96 vs. 1.03 ± 1.96 mm, P<0.0001). The diagnostic ability of global PATS was good (area under the curve = 0.897), and a threshold of 1.2 mm had a specificity of 100%, a sensitivity of 55%, and an accuracy of 78.82%. Conclusion An axial global PATS of 1.2 mm on MRI is greatly specific for identifying a functionally deficient ACL in patients with advanced AMOA.

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“…A greater cross-sectional area-to-length ratio was increased in males, and this difference between males and females increased with age. 1 A greater cross-sectional area would seem to correlate with more strength, but it is a hypothesis that would need to be tested. It would also be interesting to compare injury rates in adults vs children of different genders to see if this change is truly related to the cross-sectional area.…”

mentioning

confidence: 99%