Association of Anterior Cruciate Ligament Width With Anterior Knee Laxity

Wang, Hsin‐Min; Shultz, Sandra J.; Schmitz, Randy J.

doi:10.4085/1062-6050-51.7.07

Cited by 10 publications

(12 citation statements)

References 27 publications

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“…Further work is needed to determine the extent to which ACL size and strength are modifiable through training designed to specifically load and strengthen the bone-ligament-bone complex. Finally, Wang et al 22 reported a negative relationship between ACL size and anterior knee laxity. If ACL size and structural quality reflect ACL function, measuring laxity may give insights into ligament size as an aspect of screening.…”

Section: Discussionmentioning

confidence: 96%

“…We assessed ACL width using MIPAV software (National Institutes of Health, Bethesda, MD) per previously described methods. 12,22 The sagittal-plane slice that showed the clearest image of the Blumensaat line was selected. A line on the point of the notch outlet that was drawn perpendicular to the Blumensaat line across the ACL was defined as the ACL width ( Figure 2).…”

Section: Morphometric Data Reductionmentioning

confidence: 99%

“…A line on the point of the notch outlet that was drawn perpendicular to the Blumensaat line across the ACL was defined as the ACL width ( Figure 2). The investigator had previously established intratester measurement consis- 22 The ACL CSA was measured with ITK-SNAP software 23 using methods reported by Whitney et al 7 From an oblique sagittal-plane image perpendicular to the ACL, a point at one-third of the total ACL length from the attachment to the tibia was identified ( Figure 3A). After this point was identified, the ACL CSA was segmented and calculated from the oblique axial image ( Figure 3B).…”

Section: Morphometric Data Reductionmentioning

confidence: 99%

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Sex Comparisons of In Vivo Anterior Cruciate Ligament Morphometry

Wang

Shultz

Ross

et al. 2019

Journal of Athletic Training

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Context Females have consistently higher anterior cruciate ligament (ACL) injury rates than males. The reasons for this disparity are not fully understood. Whereas ACL morphometric characteristics are associated with injury risk and females have a smaller absolute ACL size, comprehensive sex comparisons that adequately account for sex differences in body mass index (BMI) have been limited. Objective To investigate sex differences among in vivo ACL morphometric measures before and after controlling for femoral notch width and BMI. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants Twenty recreationally active men (age = 23.2 ± 2.9 years, height = 180.4 ± 6.7 cm, mass = 84.0 ± 10.9 kg) and 20 recreationally active women (age = 21.3 ± 2.3 years, height = 166.9 ± 7.7 cm, mass = 61.9 ± 7.2 kg) participated. Main Outcome Measure(s) Structural magnetic resonance imaging sequences were performed on the left knee. Anterior cruciate ligament volume, width, and cross-sectional area measures were obtained from T2-weighted images and normalized to femoral notch width and BMI. Femoral notch width was measured from T1-weighted images. We used independent-samples t tests to examine sex differences in absolute and normalized measures. Results Men had greater absolute ACL volume (1712.2 ± 356.3 versus 1200.1 ± 337.8 mm3; t38 = −4.67, P < .001) and ACL width (8.5 ± 2.3 versus 7.0 ± 1.2 mm; t38 = −2.53, P = .02) than women. The ACL volume remained greater in men than in women after controlling for femoral notch width (89.31 ± 15.63 versus 72.42 ± 16.82 mm3/mm; t38 = −3.29, P = .002) and BMI (67.13 ± 15.40 versus 54.69 ± 16.39 mm3/kg/m2; t38 = −2.47, P = .02). Conclusions Whereas men had greater ACL volume and width than women, only ACL volume remained different when we accounted for femoral notch width and BMI. This suggests that ACL volume may be an appropriate measure of ACL anatomy in investigations of ACL morphometry and ACL injury risk that include sex comparisons.

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Section: Discussionmentioning

confidence: 96%

Section: Morphometric Data Reductionmentioning

confidence: 99%

Section: Morphometric Data Reductionmentioning

confidence: 99%

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Sex Comparisons of In Vivo Anterior Cruciate Ligament Morphometry

Wang

Shultz

Ross

et al. 2019

Journal of Athletic Training

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“…The current finding that a smaller ACL volume was associated with greater AKL is consistent with previous animal and human studies reporting that a smaller ACL size was associated with greater AKL. 19,51 A previous computational study indicated that smaller ACL graft sizes led to greater strain on the ligament during loading, 52 with an animal study also reporting that smaller ACL graft volumes had lower failure loads. 17 These findings collectively suggest that a smaller in vivo ACL volume is less capable of resisting external forces, thus likely leading to greater AKL and potentially lower failure loads.…”

Section: Discussionmentioning

confidence: 99%

“… 19 We are aware of only 1 study in humans in which a significant but weaker relationship was observed between ACL width and AKL ( R 2 = 0.22). 51 Thus, the size of the ligament may not be the only determinant of ligamentous behavior under loading.…”

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confidence: 99%

Relationship of Anterior Cruciate Ligament Volume and T2* Relaxation Time to Anterior Knee Laxity

Wang

Shultz

Ross

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: High anterior knee laxity (AKL) has been prospectively identified as a risk factor for anterior cruciate ligament (ACL) injuries. Given that ACL morphometry and structural composition have the potential to influence ligamentous strength, understanding how these factors are associated with greater AKL is warranted. Hypothesis: Smaller ACL volumes combined with longer T2* relaxation times would collectively predict greater AKL. Study Design: Cross-sectional study; Level of evidence, 3. Methods: College-aged active male (n = 20) and female (n = 30) participants underwent magnetic resonance imaging (MRI) and AKL testing. T2-weighted MRI scans were used to assess ACL volumes, and T2* relaxation times were used to assess ACL structural composition. AKL was measured via a commercial knee arthrometer. Forward stepwise linear regression with sex and weight (first step; suppressor variables) as well as ACL volume and T2* relaxation time (second step; independent variables) was used to predict AKL (dependent variable). Results: After initially adjusting for sex and weight ( R 2 = 0.19; P = .006), smaller ACL volumes combined with longer T2* relaxation times collectively predicted greater AKL ( R 2 = 0.52; P < .001; R 2 Δ = 0.32; P Δ < .001). A smaller ACL volume was the primary predictor of greater AKL ( R 2 Δ = 0.28; P < .001), with a longer T2* relaxation time trending toward a significant contribution to greater AKL ( R 2 Δ = 0.04; P = .062). After adjusting for ACL volume and T2* relaxation time, sex (partial r = 0.05; P = .735) and weight (partial r = 0.05; P = .725) were no longer significant predictors. Conclusion: AKL was largely predicted by ACL volume and to a lesser extent by T2* relaxation time (and not a person’s sex and weight). These findings enhance our understanding of how AKL may be associated with a structurally weaker ACL. The current study presents initial evidence that AKL is a cost-effective and clinically accessible measure that shows us something about the structural composition of the ACL. As AKL has been consistently shown to be a risk factor for ACL injuries, work should be done to continue to investigate what AKL may tell a clinician about the structure and composition of the ACL.

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

Hosseinzadeh

Kiapour

2020

Journal Orthopaedic Research

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Despite a well-established role of anterior cruciate ligament (ACL) anatomy on its biomechanics, little is known on how ACL anatomy develops and changes during skeletal growth. We hypothesized that ACL size and orientation will change by age during skeletal growth and maturation with different trends in males vs females. Magnetic resonance images of 269 unique knees (3-18 years old; 51% female) were used to measure ACL length, cross-sectional area, length-to-cross-sectional area ratio, and elevation angles. In both males and females, ACLs became longer, thicker, and more vertical in sagittal and coronal planes by increasing age (R 2 > 0.2; P < .001 for all associations). ACL cross-sectional area-to-length ratio increased by age only in males (R 2 = 0.06; P = .003). Despite similar ACL sizes between males and females at early age, adolescent males had significantly longer and thicker ACLs compared to the age-matched females (P < .05). There were no sex differences in ACL elevation angles (P > .2) except for larger coronal elevation in 7 to 10 years old females compared to age-matched males (P = .012). Observed changes in ACL cross-sectional area-to-length ratio indicate that age-and sex-dependent changes in ACL size are not homogenous. The trends seen in normalized ACL size measurements suggest that unlike ACL cross-sectional area, ACL length is primarily controlled by body size. Smaller ACLs and lower cross-sectional growth rates observed in females may be contributing factors to the higher risk of ACL injuries in females. Further investigations are required to identify the intrinsic and extrinsic factors responsible for these discrepancies.

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Association of Anterior Cruciate Ligament Width With Anterior Knee Laxity

Cited by 10 publications

References 27 publications

Sex Comparisons of In Vivo Anterior Cruciate Ligament Morphometry

Sex Comparisons of In Vivo Anterior Cruciate Ligament Morphometry

Relationship of Anterior Cruciate Ligament Volume and T2* Relaxation Time to Anterior Knee Laxity

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

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