The Chinese ACL injury population has a higher proportion of small ACL tibial insertion sizes than Western patients

Li, Feilong; Qin, Leilei; Gong, Xuan; Huang, Zhenggu; Wang, Ting; Liu, Ziming; Sandiford, Steve; Yang, Jianye; Zhu, Sizheng; Liu, Xi; Huang, Wei; Hu, Ning

doi:10.1007/s00167-019-05541-z

Cited by 6 publications

(5 citation statements)

References 49 publications

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“…Injury trends within the Women’s National Basketball Association (WNBA) help illustrate potential disparities by race, with White athletes having more than 6 times the ACL tear rate of other ethnic groups combined [ 83 ]. Data of Han Chinese patients with ACL injuries shows a higher proportion of patients with a small tibial footprint size compared to Western populations with ACL injuries, suggesting differences in tibial footprint size could play a role between races [ 84 , 85 ]. There is a paucity of studies and limited data on racial and ethnic predisposition to ACL injury despite well-described anatomic differences.…”

Section: Disparities In Race and Ethnicitymentioning

confidence: 99%

Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes

Devana

Solórzano

Nwachukwu

et al. 2021

Curr Rev Musculoskelet Med

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Purpose of Review Anterior cruciate ligament (ACL) rupture is a common injury that has important clinical and economic implications. We aimed to review the literature to identify gender, racial and ethnic disparities in incidence, treatment, and outcomes of ACL injury. Recent Findings Females are at increased risk for ACL injury compared to males. Intrinsic differences such as increased quadriceps angle and increased posterior tibial slope may be contributing factors. Despite lower rates of injury, males undergo ACL reconstruction (ACLR) more frequently. There is conflicting evidence regarding gender differences in graft failure and ACL revision rates, but males demonstrate higher return to sport (RTS) rates. Females report worse functional outcome scores and have worse biomechanical metrics following ACLR. Direct evidence of racial and ethnic disparities is limited, but present. White athletes have greater risk of ACL injury compared to Black athletes. Non-White and Spanish-speaking patients are less likely to undergo ACLR after ACL tear. Black and Hispanic youth have greater surgical delay to ACLR, increased risk for loss to clinical follow-up, and less physical therapy sessions, thereby leading to greater deficits in knee extensor strength during rehabilitation. Hispanic and Black patients also have greater risk for hospital admission after ACLR, though this disparity is improving. Summary Females have higher rates of ACL injury with inconclusive evidence on anatomic predisposition and ACL failure rate differences between genders. Recent literature has suggested inferior RTS and functional outcomes following ACLR in females. Though there is limited and mixed data on incidence and outcome differences between races and ethnic groups, recent studies suggest there may be disparities in those who undergo ACLR and time to treatment.

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Section: Disparities In Race and Ethnicitymentioning

confidence: 99%

Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes

Devana

Solórzano

Nwachukwu

et al. 2021

Curr Rev Musculoskelet Med

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“…For these reasons, the ACL has been the subject of many anatomical studies, and recent studies have used advances in technology to better control knee loading during measurement and more accurately characterize the complex tissue morphology. Most studies have described the native ACL as having an hourglass shape with direct midsubstance attachments and thin, membranous, peripheral attachments, at both the femoral and tibial insertion sites [1, 3, 5, 6, 8, 10]. Harner et al, used a digital measurement system to quantify the ACL dimensions and found that the cross‐sectional areas at the femoral and tibial insertion areas were over three times larger that of the midsubstance cross‐sectional area [6].…”

Section: Introductionmentioning

confidence: 99%

The femoral posterior fan-like extension of the ACL insertion increases the failure load

Sabzevari

Shaikh

Marshall

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose To examine the role of the posterior fan‐like extension of the ACL's femoral footprint on the ACL failure load. Methods Sixteen (n = 16) fresh frozen, mature porcine knees were used in this study and randomized into two groups (n = 8): intact femoral ACL insertion (ACL intact group) and cut posterior fan‐like extension of the ACL (ACL cut group). In the ACL cut group, flexing the knees to 90°, created a folded border between the posterior fan‐like extension and the midsubstance insertion of the femoral ACL footprint and the posterior fan‐like extension was dissected and both areas were measured. Specimens were placed in a testing machine at 30° of flexion and subjected to anterior tibial loading (60 mm/min) until ACL failure. Results The intact ACL group had a femoral insertion area of 182.1 ± 17.1 mm2. In the ACL cut group, the midsubstance insertion area was 113.3 ± 16.6 mm2, and the cut posterior fan‐like extension portion area was 67.1 ± 8.3 mm2. The failure load of the ACL intact group was 3599 ± 457 N and was significantly higher (p < 0.001) than the failure load of the ACL cut group 392 ± 83 N. Conclusion Transection of the posterior fan‐like extension of the ACL femoral footprint has a significant effect on the failure load of the ligament during anterior loading at full extension. Regarding clinical relevance, this study suggests the importance of the posterior fan‐like extension of the ACL footprint which potentially may be retained with remnant preservation during ACL reconstruction. Femoral insertion remnant preservation may allow incorporation of the fan‐like structure into the graft increasing graft strength.

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“…Our ndings suggest that the prevalence of noncontact ACL injuries and associated posterolateral tibial plateau fractures in our East China cohort is lower than previously documented in European and American populations. Differing femoral and tibial morphologies attributable to racial variations may account for this discrepancy (19)(20)(21)(22)(23). Other factors include China's national conditions, such as the widespread use of motorized two-wheelers and the lower engagement in contact sports, although the true incidence of ACL injuries in the vast Chinese population remains largely unquanti ed.…”

Section: Discussionmentioning

confidence: 99%

Incidence of posterolateral tibia plateau fractures and concomitant injuries in Chinese patients who underwent an anterior cruciate ligament reconstruction

Jiang,

Zhu,

Jia

et al. 2023

Preprint

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Objective The purpose of the present study was to report the incidence and classify the morphological subtypes of posterolateral tibial plateau fractures accompanying anterior cruciate ligament (ACL) tears in an East China population, as well as to evaluate the implications of such injuries on the functional recovery following ACL reconstruction. Methods 488 cases of patients treated for ACL rupture between January 2016 and June 2020 were retrospectively reviewed, and their posterolateral tibial plateau fractures were classified based on MRI assessment. Functional outcomes were evaluated at a two-year postoperative follow-up using a range of validated scoring systems. Results The study identified a high incidence of posterolateral tibial plateau fractures (41.6%) among ACL injury cases, with type ⅢA and ⅢB fractures occurring more frequently. Patients with high-grade fractures experienced significantly lower functional recovery than those with low-grade injuries. Major findings included noncontact mechanism predominance in ACL injuries, a higher occurrence rate of type ⅢA and ⅢB fractures among older females, and a substantial association with meniscal and medial collateral ligament tears. Conclusions The incidence and distinct morphological classification of posterolateral tibial plateau fractures are clinically significant in ACL injury cases. The higher grade posterotibial plateau fractures are associated with worse functional outcomes in patients undergoing an ACLR.

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The Chinese ACL injury population has a higher proportion of small ACL tibial insertion sizes than Western patients

Cited by 6 publications

References 49 publications

Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes

Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes

The femoral posterior fan-like extension of the ACL insertion increases the failure load

Incidence of posterolateral tibia plateau fractures and concomitant injuries in Chinese patients who underwent an anterior cruciate ligament reconstruction

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