Introducing the Lateral Femoral Condyle Index as a Risk Factor for Anterior Cruciate Ligament Injury: Letter to the Editor

Li, Ruibo; Liu, Yuehong; Fang, Zhi; Zhang, Jianjun

doi:10.1177/0363546520920546

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…In knees without this notch, however, there can be uncertainty and randomness in determining the most inferior points. 15 We observed 2 types of ambiguous geometries of the distal lateral femoral condyle that made it difficult to draw accurate circles, both of which did not include this notch: (1) a horizontal connection between the anterior and posterior aspects of the condyle (Figure 2); and (2) a sloped line connecting the anterior and posterior aspects of the condyle (Figure 3). When the notch is absent, multiple sizes of the extension circle can fit the criteria.…”

Section: Discussionmentioning

confidence: 99%

“…First, the measurement of this index can entail uncertainty and randomness due to potential ambiguity in the protocol. 15 Second, the experimental group of patients with ACL injury was heterogeneous in terms of their injury mechanism (ie, data from contact and noncontact mechanisms were combined) 15 even though the literature shows that the majority of ACL injuries are caused by a noncontact mechanism, 1,6 when tibiofemoral geometry most likely has the greatest role. Third, the LFCI was measured in the injured knee of the patients with primary ACL injury, which assumes the trauma did not modify geometric characteristics of the knee.…”

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confidence: 99%

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The Lateral Femoral Condyle Index Is Not a Risk Factor for Primary Noncontact Anterior Cruciate Ligament Injury

et al. 2021

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Background: The lateral femoral condyle index (LFCI)—a recently developed measure of the sphericity of the lateral femoral condyle—was reported to be a risk factor for anterior cruciate ligament (ACL) injury. However, issues have been raised regarding how the index was measured and regarding the patient group and the knee in which it was measured. Purpose: To investigate the association between the LFCI and the risk of sustaining a primary, noncontact ACL injury, and to examine whether this association was moderated by the posterior-inferior–directed slope of the lateral tibial plateau. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A secondary analysis was conducted of deidentified magnetic resonance images of the uninjured knees of 86 athletes with ACL injury and the corresponding knees of 86 control athletes, matched for sports team, sex, and age. From those images, we measured the LFCI and the posterior-inferior–directed slope of the middle region articular cartilage surface of the tibial plateau’s lateral compartment. Conditional logistic regressions were performed to determine whether the LFCI was significantly associated with ACL injury risk and whether the lateral tibial compartment middle cartilage slope moderated this association. Data were analyzed for female and male participants separately as well as for both groups combined. Results: The LFCI was not found to be significantly associated with experiencing a primary, noncontact ACL injury for all analyses. The lateral tibial slope measure was not found to moderate the association between the LFCI and ACL injury. A conditional logistic regression analysis using the LFCI data of the injured knees, instead of the uninjured knees, of the participants with ACL injury revealed that the LFCI was significantly associated with ACL injury. Conclusion: In this population of athletically active female and male participants, the LFCI was not found to be a risk factor for noncontact ACL injury, regardless of the geometric features of the lateral tibial slope.

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Section: Discussionmentioning

confidence: 99%

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The Lateral Femoral Condyle Index Is Not a Risk Factor for Primary Noncontact Anterior Cruciate Ligament Injury

et al. 2021

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“…In other words, the flexion circle and extension circle were drawn before and after the lateral femoral condyle, respectively, and the ratio of the radius of the two circles was considered the lateral femoral condyle index [ 10 ]. However, Li et al indicated that the two circles had great uncertainty and randomness, possibly leading to large errors of this measurement method [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Increased lateral femoral condyle ratio measured by MRI is associated with higher risk of noncontact anterior cruciate ligament injury

2022

BMC Musculoskelet Disord

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Background Studies have shown a significant association between the radiographically measured lateral femoral condyle ratio (LFCR) and anterior cruciate ligament (ACL) injury. However, it is unclear whether LFCR measured by magnetic resonance imaging (MRI) is associated with a higher risk of noncontact ACL injury. Objective To investigate the effect of LFCR on the risk of noncontact ACL injury by MRI. 2 to investigate the association of LFCR measured by MRI with multiple bone morphological risk factors and evaluate the most sensitive risk predictors of noncontact ACL injury. Methods A total of 116 patients, including 58 subjects with noncontact ACL injury and 58 age-matched and sex-matched controls with only meniscus injury, were included in this retrospective case-control study. LFCR, lateral tibial slope (LTS), lateral tibial height (LTH), medial tibial slope (MTS), and medial tibial depth (MTD) were measured on MRI. The differences in each index between the two groups were compared, and risk factors were screened by single-factor logistic regression analysis. Indicators with P values < 0.1 were included in the logistic regression equation. The critical values and areas under the curve (AUCs) of independent risk factors were determined by receiver operating characteristic (ROC) curve analysis. Finally, the diagnostic performance of each risk factor was evaluated by the Z-test. Results A total of 116 patients who met the inclusion criteria were included in the final analysis (58 cases in the noncontact ACL injury group and 58 cases in the control group). Patients with noncontact ACL injury had a higher femoral LFCR (0.64 ± 0.03) than patients with isolated meniscus tears. Among all the risk factors for ACL injury, the AUC for LFCR was the largest, at 0.81 (95% CI, 0.73-0.88), and when the critical value was 0.61, the sensitivity and specificity for the diagnosis of ACL injury were 0.79 and 0.67, respectively. When combined with LTH (> 2.35 mm), the diagnostic performance was improved. The AUC was 0.85 (95% CI, 0.78-0.92), the sensitivity was 0.83, and the specificity was 0.76. Conclusion This study shows that an increased LFCR is related to an increased risk of noncontact ACL injury as determined by MRI. LFCR and LTH are sensitive risk factors for noncontact ACL injury and may help clinicians identify individuals prone to ACL injury, allowing prevention and intervention measures to be applied.

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“…In other words, the exion circle and extension circle were drawn before and after the lateral femoral condyle, respectively, and the ratio of the radius of the two circles was considered the lateral femoral condyle index [10]. However, Li et al believed that the two circles had great uncertainty and randomness, so this measurement method may have large errors [20].…”

Section: Discussionmentioning

confidence: 99%

Increased Lateral Femoral Condyle Ratio Measured by MRI Is Associated with Higher Risk of Noncontact Anterior Cruciate Ligament Injury

2021

Preprint

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Background Studies have shown a significant association between the radiographically measured lateral femoral condyle ratio (LFCR) and anterior cruciate ligament (ACL) injury. However, it is unclear whether the the LFCR measured by magnetic resonance imaging (MRI) is associated with risk of noncontact ACL injury. Objective 1 To investigate the effect of the LFCR on the risk of noncontact ACL injury by MRI. 2 To investigate the association of the LFCR measured by MRI with multiple bone morphological risk factors and evaluate the most sensitive risk predictors of noncontact ACL injury. Methods A total of 116 patients, including 58 subjects with noncontact ACL injury and 58 age-matched and sex-matched controls with only meniscus injury, were included in this retrospective case-control study. The LFCR, lateral tibial slope (LTS), lateral tibial height (LTH), medial tibial slope (MTS), and medial tibial depth (MTD) were measured on MRI. The differences in each index between the two groups were compared, and risk factors were screened by single-factor logistic regression analysis. Indicators with P values <0.1 were included in the logistic regression equation. The critical values and areas under the curve (AUCs) of independent risk factors were determined by receiver operating characteristic (ROC) curve analysis. Finally, the diagnostic performance of each risk factor was evaluated by the Z-test. Results A total of 116 patients who met the inclusion criteria were included in the final analysis (58 cases in the noncontact ACL injury group and 58 cases in the control group). Patients with noncontact ACL injury had a higher femoral LFCR (63.5±2.7%) than patients with simple meniscus tear. Among all the risk factors for ACL injury, the AUC for the LFCR was the largest, at 0.81 (95% CI, 0.73-0.88), and when the critical value was 61.35%, the sensitivity and specificity for the diagnosis of ACL injury were 79% and 67%, respectively. Combined with the LTH (> 2.35 mm), the diagnostic performance was improved. The AUC was 0.85 (95% CI, 0.78-0.92), the sensitivity was 0.83, and the specificity was 0.76 Conclusion This study shows that an increased LFCR is related to an increased risk of noncontact ACL injury by MRI. The LFCR and LTH are the most sensitive risk factors for noncontact ACL injury and may help clinicians identify individuals prone to ACL injury, allowing prevention and intervention measures to be applied.

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Introducing the Lateral Femoral Condyle Index as a Risk Factor for Anterior Cruciate Ligament Injury: Letter to the Editor

Cited by 7 publications

References 5 publications

The Lateral Femoral Condyle Index Is Not a Risk Factor for Primary Noncontact Anterior Cruciate Ligament Injury

The Lateral Femoral Condyle Index Is Not a Risk Factor for Primary Noncontact Anterior Cruciate Ligament Injury

Increased lateral femoral condyle ratio measured by MRI is associated with higher risk of noncontact anterior cruciate ligament injury

Increased Lateral Femoral Condyle Ratio Measured by MRI Is Associated with Higher Risk of Noncontact Anterior Cruciate Ligament Injury

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