The Familial Predisposition toward Tearing the Anterior Cruciate Ligament

Flynn, Rachel; Pedersen, Cheryl; Birmingham, Trevor B.; Kirkley, Alexandra; Jackowski, Dianne; Fowler, Peter

doi:10.1177/0363546504265678

Cited by 171 publications

(171 citation statements)

References 23 publications

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“…Most importantly, multivariate analysis allowed for the identification of variable combinations that were more predictive of risk than were individual factors. 20 This work confirmed research by Flynn et al 24 (who found that family history of an ACL injury was a strong predictor of injury) as well as investigations 25,26 that described associations between knee laxity and the risk of ACL injury.…”

Section: Development Of Acl Injury Risk Modelssupporting

confidence: 87%

A Sex-Stratified Multivariate Risk Factor Model for Anterior Cruciate Ligament Injury

Beynnon¹,

Sturnick

Argentieri³

et al. 2015

Journal of Athletic Training

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A nterior cruciate ligament (ACL) injuries produce significant joint trauma and have been implicated as the inciting event for both short-term and longterm changes within the articular structures of the knee. [1][2][3][4][5][6][7][8] Regardless of whether a patient chooses surgical or nonsurgical treatment, ACL injury is associated with the onset of posttraumatic arthritis. 9 Consequently, recent researchers have focused on understanding the mechanisms and factors that place individuals at increased risk for sustaining this severe injury. However, variations in study designs and methods have led to conflicting reports regarding these relationships. For example, exclusion criteria used for control participants (eg, combining control participants who have a history of knee pain with those who have normal, pain-free knees) and the approaches used to match case and control participants vary widely among studies. In addition, previous authors have obtained data from the affected knees of ACL-injured patients after the injury. This approach does not take into consideration that the ACL injury itself is capable of producing both shortterm and long-term changes in knee-joint geometry. 1,5 Furthermore, few investigators have used measurement techniques with established interobserver and intraobserver measurement reliability.10 Finally, many researchers have evaluated men and women as a combined group. However, in light of the disparities that exist between the sexes in ACL injury rates, knee-joint geometry, anatomical alignment, joint laxity, demographic characteristics, and strength, male and female models of injury risk should be considered separately. 11This keynote presentation provided a summary of findings from our group's previous and ongoing research efforts that have focused on identifying the factors associated with increased risk of ACL injury. For clarity, the findings are organized in 3 sections: ''Epidemiology of ACL Injury,'' ''Evaluation of ACL Injury Screening Tools,'' and ''Development of ACL Injury Risk Models.'' Epidemiology of ACL InjuryOur epidemiology investigation evaluated the independent effects of athlete sex, level of competition, and sport on the risk of sustaining an ACL injury. 11 We prospectively followed athletes from 26 institutions (8 colleges, 18 high schools) over 4 years to determine the incidence of firsttime, noncontact ACL injuries. After controlling for differences in level of play and sport, we found that an athlete's sex had an independent influence on the risk of injury: female athletes' risk of experiencing a noncontact ACL injury was 2.10 times greater than that of their male counterparts.11 When athlete sex and sport were controlled, collegiate athletes were at greater risk for incurring a noncontact ACL injury than were high school athletes (relative risk [RR] ¼ 2.38). 11When controlling for athlete sex and level of play, we observed that the risk of sustaining a noncontact ACL injury was greatest in soccer (RR ¼ 1.77) and rugby (RR ¼ 2.23) compared with all other sports s...

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Section: Development Of Acl Injury Risk Modelssupporting

confidence: 87%

A Sex-Stratified Multivariate Risk Factor Model for Anterior Cruciate Ligament Injury

Beynnon¹,

Sturnick

Argentieri³

et al. 2015

Journal of Athletic Training

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“…Our results may provide further insight into potential traits underlying the apparent familial predisposition toward rotator cuff tendon and ACL rupturing. 8,9 The tendons and knee joints from the selected inbred mice exhibited normal tissue phenotypes, and therefore are relevant to the study of variability of nonpathologic soft tissue traits. Although transgenic approaches (e.g., gene mutations) and knockouts are useful in isolating the effects of a single gene or group of genes on a phenotypic trait, 18 they tend to result in tissue phenotypes relevant to a disease state.…”

Section: Discussionmentioning

confidence: 99%

“…The heritability of joint laxity was proposed as early as the mid17th century, 5 and is now well documented clinically. 6,7 Recently, separate studies have demonstrated a genetic predisposition towards tendon and ligament fragility, reporting that individuals are more than twice as likely to rupture their ACL 8 or develop full-thickness rotator cuff tendon tears 9 if their parents, siblings, or children have also sustained these injuries. Despite the documented influence of hereditary factors in joint abnormalities and tendon and ligament injury, little is known regarding the genetic variability of the functional properties of these connective tissues.…”

Section: Introductionmentioning

confidence: 99%

Variability in tendon and knee joint biomechanics among inbred mouse strains

Wang

Banack

Tsai

et al. 2006

Journal Orthopaedic Research

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Hereditary factors are thought to be responsible for impaired tendon function and joint laxity. The present study investigated the genotypic variability of knee laxity and stiffness and tendon mechanical and geometric properties among 16-week-old female A/J, C57BL/6J (B6), and C3H/HeJ (C3H) inbred mice. In one group of mice, knee mechanics were quantified using a custom loading apparatus enabling translation of the tibia against a stationary femur. In a second group, flexor digitorum longus and Achilles tendons from the left hind limb underwent biomechanical testing, while those of the contralateral limb were analyzed histologically for determination of crosssectional area. Our results demonstrate that tendon and joint mechanics varied significantly among the inbred mouse strains, indicating that biomechanical properties are genetically determined. A/J mouse knees exhibited greater laxity (p < 0.001) and lower stiffness (p < 0.001) compared to those of the B6 and C3H mice. The genotypic differences in whole joint properties were similar to those of the tendons' structural biomechanical traits. Although body mass did not differ (p > 0.2) among the three strains, significant genotypic differences were found at the whole tendon, material quality, and morphological levels of the tissue hierarchy. Furthermore, genetic regulation of tendon mechanical properties varied with anatomic site. Patterns of genotypic differences in tendon size were not consistent with those of biomechanical properties, suggesting that unique combinations of structural and compositional factors contribute to tendon growth, adaptation, and development. Therefore, the three inbred strains constitute a useful experimental model to elucidate genetic control of structure-function relationships in normal and healing tendons and ligaments.

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“…Although limited information is available in the literature regarding the genetic factors that may contribute to an athlete's risk for ACL injury [14,88,89], there is evidence that there may be a familial predisposition [14,88,89]. Fraternal twin sisters we screened before their subsequent ACL injuries showed multiple potential risk factors including increased knee abduction angles, decreased knee flexion angles, increased generalized joint laxity, decreased hamstrings/quadriceps torque ratios, and smaller femoral condylar notch widths may be subject to familial predisposition [31].…”

Section: Risk Factors and Mechanismsmentioning

confidence: 99%

The 2012 ABJS Nicolas Andry Award: The Sequence of Prevention: A Systematic Approach to Prevent Anterior Cruciate Ligament Injury

Hewett

Myer

Ford

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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The Familial Predisposition toward Tearing the Anterior Cruciate Ligament

Abstract: Future research should concentrate on identifying the potentially modifiable risk factors that may be passed through families and developing strategies for the prevention of anterior cruciate ligament injuries.

Cited by 171 publications

References 23 publications

A Sex-Stratified Multivariate Risk Factor Model for Anterior Cruciate Ligament Injury

A Sex-Stratified Multivariate Risk Factor Model for Anterior Cruciate Ligament Injury

Variability in tendon and knee joint biomechanics among inbred mouse strains

The 2012 ABJS Nicolas Andry Award: The Sequence of Prevention: A Systematic Approach to Prevent Anterior Cruciate Ligament Injury

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