Tibial articular cartilage and meniscus geometries combine to influence female risk of anterior cruciate ligament injury

Abstract

Tibial plateau subchondral bone geometry has been associated with the risk of sustaining a non-contact ACL injury; however, little is known regarding the influence of the meniscus and articular cartilage interface geometry on risk. We hypothesized that geometries of the tibial plateau articular cartilage surface and meniscus were individually associated with the risk of non-contact ACL injury. In addition, we hypothesized that the associations were independent of the underlying subchondral bone geometry. MRI scans were acquired on 88 subjects that suffered non-contact ACL injuries (27 males, 61 females) and 88 matched control subjects that were selected from the injured subject's teammates and were thus matched on sex, sport, level of play, and exposure to risk of injury. Multivariate analysis of the female data revealed that increased posterior-inferior directed slope of the middle articular cartilage region and decreased height of the posterior horn of the meniscus in the lateral compartment were associated with increased risk of sustaining a first time, non-contact ACL injury, independent of each other and of the slope of the tibial plateau subchondral bone. No measures were independently related to risk of non-contact ACL injury among males. ß 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32: 1487-1494, 2014. Injuries to the anterior cruciate ligament (ACL) of the knee are often immediately debilitating and can lead to post-traumatic osteoarthritis (PTOA) regardless of whether the ACL injuries are treated with surgical intervention or rehabilitation alone.1 Since current treatment options are ineffective in preventing PTOA, recent research has focused on reducing the incidence of ACL injuries. To achieve this it is necessary to thoroughly understand the risk factors for ACL injury, so that appropriate interventions can be developed and targeted at those most at risk. Risk factors for ACL injury are multifactorial and may be different for males and females.2 A few identified risk factors, such as neuromuscular control, are modifiable and may be intervened upon. Others risk factors, such as knee geometry, are not modifiable but may play a critical role in identifying individuals at increased risk for ACL injury who may benefit from alternative preventive strategies.Tibial plateau subchondral bone geometry has been associated with knee biomechanics and ACL strain values, which influence ACL injury risk. Research has shown that increased posterior-inferior directed slope of the tibial plateau subchondral bone is associated with increased anterior translation of the tibia relative to the femur 3 and increased ACL strain values 4,5 in response to compressive loading of the knee. In addition, this increased posteriorinferior directed slope of the subchondral bone, primarily in the lateral compartment and in females, is associated with an increased risk of suffering an ACL injury. [6][7][8][9][10] While previous reports have focused on analyses of subchondral bone ...

Biomechanical and Neuromuscular Characteristics of Male Athletes: Implications for the Development of Anterior Cruciate Ligament Injury Prevention Programs

“…A thorough understanding of injury mechanisms and risk factors is a crucial step towards the development of effective prevention programs. Risk factors for ACL injury have been examined in terms of environmental [72][73][74]100], anatomical [71,81,88,89], hormonal [9,84,102], genetic [37,79,86], and biomechanical/neuromuscular components [47,48,70,108,109]. However, environmental, anatomical, hormonal, and genetic risk factors are considered non-modifiable from a practical standpoint.…”

Anatomic Factors that May Predispose Female Athletes to Anterior Cruciate Ligament Injury

“…In addition, decreased posterior meniscal height due to injury or chronic degeneration can cause further inclination of the meniscal slope and ultimately present as an important risk factor for ACL injury (20,43). Together, the magnitude of the tibial and meniscal slopes has been shown to influence the biomechanics of the knee during load transmission.…”

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.…”

“…Bilateral 3-T images were obtained on all case and control participants and used to measure 32 aspects of knee anatomy. 11,16,19,21 Multivariate analysis revealed differences between females and males for the specific aspects of knee-joint geometry that had the greatest association with ACL injury risk. When male athletes were considered as a group, decreases in the wedge angle of the posterior lateral meniscal horn and ACL volume had the highest associations with the risk of sustaining a noncontact ACL injury (odds ratio [OR] ¼ 1.23 per 18 decrease in wedge angle and OR ¼ 1.43 per 0.1-cm 3 decrease in ACL volume).…”