Age, sex, body anthropometry, and ACL size predict the structural properties of the human anterior cruciate ligament

Abstract

Anterior cruciate ligament (ACL) injury continues to be at the forefront of sports injury concerns because of its impact on quality of life and joint health prognosis. One strategy is to reduce the occurrence of this injury by identifying at-risk subjects based on key putative risk factors. The purpose of our study was to develop models that predict the structural properties of a subject's ACL based on the combination of known risk factors. We hypothesized that the structural properties of the ACL can be predicted using a multi-linear regression model based on significant covariates that are associated with increased risk of injury, including age, sex, body size, and ACL size. We also hypothesized that ACL size is a significant contributor to the model. The developed models had predictive capabilities for the structural properties of the ACL: load at failure (R 2 = 0.914), elongation at failure (R 2 = 0.872), energy at failure (R 2 = 0.913), and linear stiffness (R 2 = 0.756). Furthermore, sex, age, body mass, BMI, and height were contributors (p < 0.05) to all predicted structural properties. ACL minimal area was a contributor to elongation, energy at failure, and linear stiffness (p < 0.05), but not to load at failure. ACL volume was also a contributor to elongation and energy at failure (p < 0.05), but not to linear stiffness and load at failure models. ACL length was not a significant contributor to any structural property. The clinical significance of this research is its potential, after continued development and refinement of the model, for application to prognostic studies that are designed to identify individuals at increased risk for injury to the ligament. Keywords: anterior cruciate ligament; structural properties; ACL size; body size; strength predictionThe high incidence of anterior cruciate ligament (ACL) injuries suffered by young active individuals, especially females, and the associated cost of treatment has been the subject of extensive research. [1][2][3][4] The negative impact of an ACL tear on a person's life is exacerbated by the increased risk of developing osteoarthritis (OA) when this injury is either treated with surgical reconstruction or conservatively through rehabilitation and activity modification. 5Recent research efforts have focused on determining the risk factors for ACL injury. Risk factor studies are crucial for developing intervention programs and for identifying who is at increased risk of suffering ACL injury so an intervention can be targeted at them. Such research has produced marked advances over the past decade.1 Although the question regarding sex-based disparity has not been answered, the susceptibility to ACL injury is universally believed to be multi-factorial, with complex interrelationships among key risk factors and separate risk models for males and females.1 Risk factors associated with increased risk of ACL injury include: footwear, surface type, subject sex, ACL geometry (size), femoral notch size, menstrual cycle phase, Q angle, tibial articular ...

Compliance With Neuromuscular Training and Anterior Cruciate Ligament Injury Risk Reduction in Female Athletes: A Meta-Analysis

“…8 It is accepted that noncontact ACL injury rates are higher among females than males. 9,10 Several factors have been identified to explain this sex disparity [11][12][13] ; however, a single factor to predict these sex differences in injury rates has not been identified. Anatomic and hormonal factors, such as ACL circumference, joint laxity, and menstrual phase, have been discussed as increased risk factors for noncontact ACL injuries in females.…”

Return to Play Following Anterior Cruciate Ligament Reconstruction

“…39,40 Research has correlated higher strength or biomechanical properties with lower graft or ligament SI 37,38 and larger graft or ligament volume. 37, 42,43 The same MR parameter that relates to graft biomechanical performance was also predictive of overall patient knee health and ACL reconstruction surgical outcomes. 39 Future methods of assessing graft maturity and healing through MRI may become an important clinical assessment tool to determine RTP; with greater understanding of when an ACLR has healed, it may elucidate when a graft may tolerate the forces required for athletic return.…”

A Quantitative Study of the Relationship between the Distribution of Different Types of Collagen and the Mechanical Behavior of Rabbit Medial Collateral Ligaments

“…Mechanical properties are critical contributors to the structural response and function of ligaments, and numerous factors have been studied to determine their influence on the mechanical properties of ligaments [4]–[15]. The various types of collagen (including type I and III collagen) are the major constituents in ligaments, but whether collagen types are related to the mechanical behaviors of ligaments must still be clarified.…”

“…The mechanical properties of ligaments have attracted much interest given their key contributions to the structural responses of ligaments as well as normal joint function [1]–[3]. Numerous factors have been examined to determine their effects on the mechanical properties of ligaments; these factors include water content [4], fibril crimp [5], [6], fiber orientation [7], [8], fibril diameter and density [9], [10], age [11], [12], sex [13], [14] and body and ligament anthropometry [15].…”