The necessity for identification of risk factors for Anterior Cruciate Ligament, ACL injury has challenged many investigators. Many authors have reported lower Notch Width Index, NWI measured on radiographs in patients with midsubstance ACL lesions compared to control groups. Since a narrow intercondylar notch has been implicated as a possible risk factor related to ACL injury we decided to compare NWI measured on MRI scans between age-matched groups with acute ACL injury with those of the normal population. The purpose of this study was to measure intercondylar notch width on MRI scans in an immature population to determine if there was a difference between the population with ACL tears and a control group. We also wanted to assess age as a risk factor in an ACL injury population. We retrospectively analysed the MRI scans of 46 patients with ACL injuries and 44 patients with normal MRI findings who served as a control group for NWI measurements. For the ACL injury group we collected information from medical charts including age at the time of injury, gender, mechanism of injury, type of activity practised at the time of injury and prevalence of meniscal injury. Demographic data of the control group were comparable with those from the study group. We found a statistically significant (p<0.001) difference in the mean value of the intercondylar notch width between normal knees (0.2691) and the ACL injury population (0.2415). In the ACL injury group we did not find differences in NWI values with regard to gender, involved side, mechanism of injury and type of sport practised at the time of injury. A narrower intercondylar notch was found to be associated with the risk of ACL rupture in an immature population. The young group of athletes with ACL injury needs further study to prospectively assess the risk of knee injuries.

Despite the higher incidence of anterior cruciate ligament (ACL) injuries in female than in male athletes few authors have studied the effects of gender on the outcome of ACL reconstruction. This prospective study compared the results of ACL reconstruction using the patellar tendon and hamstring techniques in men and women. We prospectively followed 80 comparable athletes (46 males, 32 females) from a population of 287 patients operated on at our institution for ACL reconstruction using either patellar tendon or hamstring graft. There were 26 males and 14 females in the patellar tendon group, and 22 males and 18 females in the hamstring group. All patients were operated on by the same surgeon within 6 months from injury and underwent the same rehabilitation program at the same center. After an average of 36 months the patients were assessed by clinical evaluation, computerized knee laxity analysis, and isokinetic and functional strength tests; standard knee scores were also used. Among patellar tendon patients there were no significant differences between males and females regarding knee evaluation form, laxity, or isokinetic and functional tests. Females in the hamstring group had significantly greater laxity, and isokinetic tests at 1 year revealed a significantly higher deficit of peak torque at 60 degrees /s in flexion and extension. We suggest further studies on the clinical significance of these findings particularly on their possible ramifications in the areas of return to sports and rehabilitation of female athletes.

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Therapeutic level 4 (case series).

PurposeIn a group of high performance weightlifters increased values of the cruciate ligaments (CLs) cross-sectional areas were observed. The purpose of this research was to investigate if repeated heavy workouts increase the volume of those structures.MethodsThe knee examinations were performed with an 1,5T MRI system. The area of the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) midsubstance cross-section were evaluated in T1-weighted images with administration of contrast medium in a group of nine athletes. A control group of 19 participants was also examined using the same protocol.ResultsSignificant differences of the ACL and the PCL midsubstance cross-sectional areas were observed between groups. The area of the CLs' midsubstance and the onset of training were strongly negatively correlated and the PCL cross-sectional area was strongly positively correlated with the duration of training.ConclusionThis research is the first description of the CLs hypertrophy, which is probably caused by heavy training that was started about the age of puberty. The age of training onset seems to have a greater impact on the hypertrophy process than the training duration. Knowledge of the phenomenon of cruciate ligament overgrowth is vital for orthopaedics because, possible changes of the CLs mechanical properties and three-dimensional orientation, may affect the incidence of trauma and reconstruction procedures technique.