Investigation of Morphometric Factors Associated With Adolescent ACL Rupture

Abstract

Background: There are no definitive anatomic morphometric risk factors for adolescent anterior cruciate ligament (ACL) injury. Purpose: To compare the parameters used to define the tibial and femoral morphometric structure of the knee between adolescent patients with and without ACL rupture. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were magnetic resonance imaging (MRI) scans and radiographs of 115 patients aged 10 to 17 years who were evaluated for ACL rupture at a single institution between February 1, 2019, and January 31, 2022. Images from 115 patients with intact MRI scans were included as controls. We investigated the following imaging parameters: tibial slope (on lateral radiograph), lateral condylar height, tibial sulcus height, medial condylar height, condylar width, intercondylar notch with, intercondylar notch angle, notch index, eminence width, tibial plateau width, eminence width/tibial plateau width, medial/lateral/overall eminence height, medial plateau depth, and 2 different eminence angles. Parameters were compared between groups using the chi-square, Fisher exact, Student t, or Mann-Whitney U test, as appropriate. Receiver operating characteristic analysis was conducted for cutoff values of significant parameters. Results: There were no significant differences in age, sex, or side affected between groups. Only the medial plateau depth was found to be statistically significant between the ACL rupture and ACL intact groups (2.6 vs 2.2 mm; P = .015). A statistically significant cutoff value could not be obtained for the medial plateau depth. Conclusion: Medial plateau depth was found to be significantly greater in adolescent patients with ACL rupture compared with ACL-intact controls.

The effect of bony morphology on anterior cruciate ligament injury and surgery

“… 21 In adolescents, MTPD was found to be significantly higher in the ACL-injured cohort compared to controls (2.6 vs. 2.2 mm; P = .015). 22 In the lateral compartment, greater convexity of the lateral tibial plateau is associated with a higher grade pivot shift. 2 , 23 Lateral plateau surface geometry contributes to tibiofemoral rotatory stability, but this has not yet been directly analyzed as a risk factor for ACL injury.…”

“…These morphologic features contribute to tibiofemoral joint stability, and variation in these parameters may portend a higher intrinsic risk for ACL injury. Specifically, steep PTS, 4 , 7 , 15 - 19 shallow medial plateau depth, 20 - 22 and greater convexity of the lateral plateau 23 have been associated with increased risk of ACL injury.…”

“…Medial tibial plateau depth (MTPD) has also been associated with ACL injury; specifically, a shallower MTPD increases ACL injury risk. 20 - 22 In 1 study, females with a shallow MTPD had a higher risk of ACL injury [odds ratio (OR) 4.13], 20 while another study found an increased risk of ACL injury with a shallow MTPD regardless of sex (OR 3.03). 21 In adolescents, MTPD was found to be significantly higher in the ACL-injured cohort compared to controls (2.6 vs. 2.2 mm; P = .015).…”