Geometric profile of the tibial plateau cartilage surface is associated with the risk of non‐contact anterior cruciate ligament injury

Abstract

The purpose of this study was to determine if geometry of the articular surfaces of the tibial plateau is associated with non-contact anterior cruciate ligament (ACL) injury. This was a longitudinal cohort study with a nested case-control analysis. Seventyeight subjects who suffered a non-contact ACL tear and a corresponding number of controls matched by age, sex, and sport underwent 3 T MRI of both knees. Surface geometry of the tibial articular cartilage was characterized with polynomial equations and comparisons were made between knees on the same person and between ACL-injured and control subjects. There was no difference in surface geometry between the knees of the control subjects. In contrast, there were significant differences in the surface geometry between the injured and normal knees of the ACL-injured subjects, suggesting that the ACL injury changed the cartilage surface profile. Therefore, comparisons were made between the uninjured knees of the ACL-injured subjects and the corresponding knees of their matched controls and this revealed significant differences in the surface geometry for the medial (p < 0.006) and lateral (p < 0.001) compartments. ACL-injured subjects tended to demonstrate a posterior-inferior directed orientation of the articular surface relative to the long axis of the tibia, while the control subjects were more likely to show a posterior-superior directed orientation. Severe knee injury, such as an anterior cruciate ligament (ACL) disruption, is often immediately disabling and has been associated with the early onset of post-traumatic osteoarthritis regardless of whether surgical or non-surgical treatment is chosen.1,2 This has motivated studies that have focused on identifying the variables associated with increased risk of ACL injury, so that prevention strategies can be developed and those at increased risk can be identified and targeted for intervention. 3During the process of suffering an ACL injury, the geometry of the articular surfaces of the knee is important in controlling the biomechanical response of the tibiofemoral joint and ACL. 4,5 For example, there appears to be a consensus forming in the literature that individuals who are at increased risk of suffering non-contact ACL disruptions have increased posteriorinferior directed slopes of the subchondral bone portion of their tibial plateaus compared to uninjured controls. [6][7][8][9][10][11][12][13][14][15][16] This relationship is important because the magnitude of ACL strain values produced by impulsive loading of the knee during common sportsrelated movements such as jump landings are directly related to the posterior-inferior directed slope of the subchondral bone of the proximal tibia. 4,17,18 Most of what is known about the relationship between the risk of suffering non-contact ACL injury and joint geometry has come from studies of the underlying subchondral bone of the tibia plateau; however, the large inter-segmental forces that are transmitted between the femur and tibia occur across the surface o...

Combined Injury to the ACL and Lateral Meniscus Alters the Geometry of Articular Cartilage and Meniscus Soon After Initial Trauma

“…Prior work has shown that increased posterior–inferior directed slope of the tibial plateau is associated with increased risk of suffering an ACL and ACL graft injury, and the increased lateral compartment posterior–inferior directed slopes found in the current study (3.6° for the ACL‐LM group and 1.6 for the ACL group) further exacerbates the chance of a second injury to the ACL graft . In addition, there is evidence that geometry of the articular cartilage and tibial plateau subchondral bone are associated with worsening cartilage degenerative changes in the lateral tibial plateau .…”

“…Characterization of the position of the tibia relative to the femur during MRI acquisition was accomplished by establishing three‐dimensional, bone‐based coordinate systems within the femur and tibia (Fig. ) . The following three‐dimensional (3D) measurements of the geometry of the tibial articular cartilage surface, underlying tibial subchondral bone, and meniscus were made relative to the 3D bone‐based coordinate systems using the approaches that have been described (Table ) .…”

“…Bone‐embedded anatomical coordinate systems for the tibia and femur. Anatomical coordinate systems were used to determine the position of the tibia relative to the femur.…”

A Sex-Stratified Multivariate Risk Factor Model for Anterior Cruciate Ligament Injury

“…The second phase focused on a multivariate evaluation of knee-joint geometry and its effect on the risk of ACL injury. [16][17][18][19][20][21] Detailed results from the first phase are currently under review for publication and, consequently, we can provide only an overview of the study design, but we encourage the reader to consider the detailed findings once they have been published. The findings from the multivariate work in the second phase have been published.…”

“…The findings from the multivariate work in the second phase have been published. [16][17][18][19][20][21] Athletes from 36 institutions (8 colleges, 28 high schools) were monitored prospectively over 4 years for the occurrence of ACL injuries. A total of 109 case participants (70 females, 39 males) who sustained a first-time grade III noncontact ACL injury during involvement in a schoolorganized sport were enrolled in the study.…”