scholarly journals Sex Differences in Anatomic Features Linked to Anterior Cruciate Ligament Injuries During Skeletal Growth and Maturation

2020 ◽  
Vol 48 (9) ◽  
pp. 2205-2212
Author(s):  
Shayan Hosseinzadeh ◽  
Ata M. Kiapour
Keyword(s):  
Sex Differences ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Skeletal Growth ◽  
Late Adolescent ◽  
Male And Female ◽  
Female Patients ◽  
Notch Width ◽  
Age Related

Background: Several anatomic features of the knee have been shown to affect joint and anterior cruciate ligament (ACL) loading and the risk of subsequent injuries. While several studies have highlighted sex differences between these anatomic features, little is known on how these differences develop during skeletal growth and maturation. Hypotheses: (A) Anatomic features linked to an ACL injury will significantly change during skeletal growth and maturation. (B) The age-related changes in anatomic features linked to an ACL injury are different between male and female patients. Study Design: Cross-sectional study; Level of evidence, 3 Methods: After institutional review board approval, magnetic resonance imaging data from 269 unique knees (patient age 3-18 years; 51% female), free from any injuries, were used to measure femoral notch width, posterior slope of the lateral tibial plateau (lateral tibial slope), medial tibial depth, tibial spine height, and posterior lateral meniscal bone angle. Linear regression was used to test the associations between age and quantified anatomic indices. Patients were then divided into 4 age groups: preschool (3-6 years), prepubertal (7-10 years), early adolescent (11-14 years), and late adolescent (15-18 years). Also, 2-way analysis of variance with the Holm-Sidak post hoc test was used to compare morphology between male and female patients in each age group. Results: The femoral notch width, medial tibial depth, and tibial spine height significantly increased with age ( P < .001). The lateral tibial slope decreased with age only in male patients ( P < .001). Except for the posterior lateral meniscal bone angle, the age-related changes in anatomy were different between male and female patients ( P < .05). On average, early and late adolescent female patients had smaller femoral notches, steeper lateral tibial slopes, flatter medial tibial plateaus, and shorter tibial spines compared with age-matched male patients ( P < .01). Conclusion: Overall, the findings supported our hypotheses, showing sex-specific changes in anatomic features linked to an ACL injury during skeletal growth and maturation. These observations help to better explain the reported age and sex differences in the prevalence of ACL injuries. The fact that most of these anatomic features undergo substantial changes during skeletal growth and maturation introduces the hypothesis that prophylactic interventions (ie, activity modification) would have the potential to reshape a maturing knee in a manner that lowers the risk of noncontact ACL injuries.

Age-Related Changes of Posterior Tibial Slope and Its Roles in Anterior Cruciate Ligament Injury

2016 ◽  
Vol 101 (1-2) ◽  
pp. 70-77 ◽  
Author(s):  
Ying-hua Sun ◽  
Lian-xu Chen ◽  
Zhao-de Jiao ◽  
Li Wang ◽  
Rui-ming Zhang ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Curve Fitting ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Age Related ◽  
Anterior Cruciate ◽  
Age Related Changes

Nearly all previous studies in posterior tibial slope (PTS) and anterior cruciate ligament (ACL) injuries ignored age-related changes, and the published data are inconsistent. The objective of this study was to reveal age-related changes of PTS and its roles in ACL injury. Data for 2618 lower limbs were included initially based on the availability of lateral X-rays and a suitable femorotibial angle. The final 1431 subjects were analyzed according to age, sex, side, and injury status. Student t-tests, 1-way analysis of variance, and curve fitting were used to analyze data. The PTS in males was greater than that in females in the 0–9 and 30–39-year-old groups, but this pattern was reversed in the 40–49, 60–69, 70–79, and 80–89-year-old groups. The PTS was greater on the left side than on the right side in the 0–9, 10–19, 50–59, 60–69, and 80–89-year-old groups. The curve fitting for PTS demonstrated a trend of first decreasing and then increasing with aging. The PTS values differed significantly between knees with an ACL injury and those without in the 20–29, 30–39, and 40–49-year-old groups but not in the 50–59-year-old group. The PTS follows a trend of first decreasing and then increasing, and its role in ACL injury changes with advancing age. The higher PTS is only unrelated to the risk of ACL injury in age groups with a lower mean PTS value.

scholarly journals Sex Comparisons of In Vivo Anterior Cruciate Ligament Morphometry

2019 ◽  
Vol 54 (5) ◽  
pp. 513-518 ◽  
Author(s):  
Hsin-Min Wang ◽  
Sandra J. Shultz ◽  
Scott E. Ross ◽  
Robert A. Henson ◽  
David H. Perrin ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Sex Differences ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Cross Sectional ◽  
Notch Width ◽  
Anterior Cruciate ◽  
Femoral Notch

Context Females have consistently higher anterior cruciate ligament (ACL) injury rates than males. The reasons for this disparity are not fully understood. Whereas ACL morphometric characteristics are associated with injury risk and females have a smaller absolute ACL size, comprehensive sex comparisons that adequately account for sex differences in body mass index (BMI) have been limited. Objective To investigate sex differences among in vivo ACL morphometric measures before and after controlling for femoral notch width and BMI. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants Twenty recreationally active men (age = 23.2 ± 2.9 years, height = 180.4 ± 6.7 cm, mass = 84.0 ± 10.9 kg) and 20 recreationally active women (age = 21.3 ± 2.3 years, height = 166.9 ± 7.7 cm, mass = 61.9 ± 7.2 kg) participated. Main Outcome Measure(s) Structural magnetic resonance imaging sequences were performed on the left knee. Anterior cruciate ligament volume, width, and cross-sectional area measures were obtained from T2-weighted images and normalized to femoral notch width and BMI. Femoral notch width was measured from T1-weighted images. We used independent-samples t tests to examine sex differences in absolute and normalized measures. Results Men had greater absolute ACL volume (1712.2 ± 356.3 versus 1200.1 ± 337.8 mm3; t38 = −4.67, P &lt; .001) and ACL width (8.5 ± 2.3 versus 7.0 ± 1.2 mm; t38 = −2.53, P = .02) than women. The ACL volume remained greater in men than in women after controlling for femoral notch width (89.31 ± 15.63 versus 72.42 ± 16.82 mm3/mm; t38 = −3.29, P = .002) and BMI (67.13 ± 15.40 versus 54.69 ± 16.39 mm3/kg/m2; t38 = −2.47, P = .02). Conclusions Whereas men had greater ACL volume and width than women, only ACL volume remained different when we accounted for femoral notch width and BMI. This suggests that ACL volume may be an appropriate measure of ACL anatomy in investigations of ACL morphometry and ACL injury risk that include sex comparisons.

Narrow Notch Width and Low Anterior Cruciate Ligament Volume Are Risk Factors for Anterior Cruciate Ligament Injury: A Magnetic Resonance Imaging-Based Study

2021 ◽  
pp. 155633162110410
Author(s):  
Ravi Gupta ◽  
Sanjay Jhatiwal ◽  
Anil Kapoor ◽  
Ravinder Kaur ◽  
Ashwani Soni ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Resonance Imaging ◽  
Posterior Tibial ◽  
Notch Width ◽  
Anterior Cruciate ◽  
Notch Width Index

Background: The relationship between anterior cruciate ligament (ACL) injury and anatomical structures is still a topic of debate. Purpose: The aim of this study was to compare knee geometry in demographically matched ACL-injured and ACL-intact athletes. Methods: We conducted a case-control study comparing 2 groups, each consisting of 55 professional athletes (44 men and 11 women): 1 group with complete ACL tears (cases) and 1 group with intact ACLs (controls). The groups were compared using magnetic resonance imaging (MRI) in terms of intercondylar notch geometry, tibial plateau characteristics, and ACL volume. Results: Among cases and controls, we found the cases had lower notch width (20.24 ± 2.68 mm vs. 22.04 ± 2.56 mm, respectively) and notch width index (0.29 ± 0.03 vs. 0.31 ± 0.03, respectively). The mean ACL volume in the cases (1181.63 mm3 ± 326 mm3) was also lower than in controls (1352.61 mm3 ± 279.84 mm3). The parameters of tibial slope geometry were comparable between groups. In addition, women had lower ACL volume than men (1254 ± 310 mm3 vs. 890 ± 267 mm3, respectively) and higher medial posterior tibial slope (4.76 ± 2.6 vs. 6.63 ± 1.83, respectively). Among cases, women had narrower notch width than men (16.9 ± 2.42 mm vs. 21.08 ± 2.03 mm). However, notch width index was comparable between male (0.3 ± 0.02) and female (0.28 ± 0.03) cases. Conclusion: Our findings suggest that narrow notch width and low ACL volume may enhance the risk of ACL injury among athletes. There was no association found between posterior tibial slope and ACL injury between athletes with injured ACLs and controls. Further study is indicated.

Sex Differences in the Relation Between Frailty and Endothelial Dysfunction in Old Mice

2021 ◽  
Author(s):  
Jazmin A Cole ◽  
Mackenzie N Kehmeier ◽  
Bradley R Bedell ◽  
Sahana Krishna Kumaran ◽  
Grant D Henson ◽  
...  
Keyword(s):  
Sex Differences ◽  
Endothelial Function ◽  
Vascular Function ◽  
Mesenteric Artery ◽  
Frailty Index ◽  
Mesenteric Arteries ◽  
Male Mice ◽  
Male And Female ◽  
Female Mice ◽  
Age Related

Abstract Vascular endothelial function declines with age on average, but there is high variability in the magnitude of this decline within populations. Measurements of frailty, known as frailty index (FI), can be used as surrogates for biological age, but it is unknown if frailty relates to the age-related decline in vascular function. To examine this relation, we studied young (4-9 months) and old (23-32 months) C57BL6 mice of both sexes. We found that FI was greater in old compared with young mice, but did not differ between old male and female mice. Middle cerebral artery (MCA) and mesenteric artery endothelium-dependent dilation (EDD) also did not differ between old male and female mice; however, there were sex differences in the relations between FI and EDD. For the MCA, FI was inversely related to EDD among old female mice, but not old male mice. In contrast, for the mesenteric artery, FI was inversely related to EDD among old male mice, but not old female mice. A higher FI was related to a greater improvement in EDD with the superoxide scavenger TEMPOL in the MCAs for old female mice and in the mesenteric arteries for old male mice. FI related to mesenteric artery gene expression negatively for extracellular superoxide dismutase (Sod3) and positively for interleukin-1β (Il1b). In summary, we found that the relation between frailty and endothelial function is dependent on sex and the artery examined. Arterial oxidative stress and pro-inflammatory signaling are potential mediators of the relations of frailty and endothelial function.

scholarly journals The Combined Effect of Body Mass Index and Tibial Slope Angles on Anterior Cruciate Ligament Injury Risk in Male Knees: A Case-Control Study

2019 ◽  
Vol 12 ◽  
pp. 117954411986792
Author(s):  
Volkan Kızılgöz ◽  
Ali Kemal Sivrioğlu ◽  
Hasan Aydın ◽  
Gökhan Ragıp Ulusoy ◽  
Türkhun Çetin ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Anterior Cruciate Ligament ◽  
Body Mass ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Receiver Operating Characteristics ◽  
Operating Characteristics ◽  
Anterior Cruciate

Introduction: Tibial slope angles (TSAs) have been identified as potential risk factors of anterior cruciate ligament (ACL) injury in the literature. A higher body mass index (BMI) might increase the risk of ACL tear because of greater axial compressive force. The aim of this study was to determine the relationship of these factors and the combined effect of BMI and TSA in determination of risk potential for ACL injury. Methods: The preoperative magnetic resonance (MR) images of 81 ACL-injured male knees and of 68 male individuals with no ACL injuries were evaluated by 2 radiologists to measure the TSA. The Mann-Whitney U-test was performed to indicate the significant difference in height, weight, and BMI values. The independent samples t-test was used to determine the differences between ACL-injured and non-injured groups regarding TSA values. Odds ratios were calculated by logistic regression tests, and receiver operating characteristics (ROC) curves revealed the area under the receiver operating characteristics curve (AUC) values to compare the relationships of these parameters with ACL injury. Results: Body mass index, lateral tibial slope (LTS), and medial tibial slope (MTS) were predictive of ACL risk injury. Body mass index alone had the greatest effect among these parameters, and there were no statistically significant differences in coronal tibial slope values between the ACL-ruptured and control groups. The greatest AUC was observed for the combination of BMI, MTS, and LTS. Conclusions: Body mass index, LTS, and MTS angles were associated with ACL injury risk and BMI + MTS + LTS together revealed the greatest effect on ACL injury.

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

2021 ◽  
Author(s):  
Miao He ◽  
Jie Li
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Anterior Cruciate Ligament ◽  
Diagnostic Performance ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Lateral Femoral Condyle ◽  
Anterior Cruciate

Abstract 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.

scholarly journals Increased Radiographic Posterior Tibial Slope Is Associated With Subsequent Injury Following Revision Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711987937 ◽  
Author(s):  
Richard J. Napier ◽  
Enrique Garcia ◽  
Brian M. Devitt ◽  
Julian A. Feller ◽  
Kate E. Webster
Keyword(s):  
Risk Factor ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Posterior Tibial ◽  
Revision Acl Reconstruction ◽  
Injury Group ◽  
Anterior Cruciate

Background: Increased posterior tibial slope has been identified as a possible risk factor for injury to the anterior cruciate ligament (ACL) and has also been shown to be associated with ACL reconstruction graft failure. It is currently unknown whether increased posterior tibial slope is an additional risk factor for further injury in the context of revision ACL reconstruction. Purpose: To determine the relationship between posterior tibial slope and further ACL injury in patients who have already undergone revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 330 eligible patients who had undergone revision ACL reconstruction between January 2007 and December 2015 were identified from a clinical database. The slope of the medial and lateral tibial plateaus was measured on perioperative lateral radiographs by 2 fellowship-trained orthopaedic surgeons using a digital software application. The number of subsequent ACL injuries (graft rupture or a contralateral injury to the native ACL) was determined at a minimum follow-up of 2 years (range, 2-8 years). Tibial slope measurements were compared between patients who sustained further ACL injury to either knee and those who did not. Results: There were 50 patients who sustained a third ACL injury: 24 of these injuries were to the knee that underwent revision ACL reconstruction, and 26 were to the contralateral knee. Medial and lateral slope values were significantly greater for the third-injury group compared with the no–third injury group (medial, 7.5° vs 6.3° [ P = .01]; lateral, 13.6° vs 11.9° [ P = .001]). Conclusion: Increased posterior tibial slope, as measured from lateral knee radiographs, was associated with increased risk of graft rupture and contralateral ACL injury after revision ACL reconstruction. This is consistent with the concept that increased posterior slope, particularly of the lateral tibial plateau, is an important risk factor for recurrent ACL injury.

Femoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy Individuals

2021 ◽  
pp. 036354652110504
Author(s):  
Grégoire Micicoi ◽  
Chistophe Jacquet ◽  
Raghbir Khakha ◽  
Sally LiArno ◽  
Ahmad Faizan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Reference Population ◽  
Acl Injuries ◽  
Notch Width ◽  
Injury Risk Factor ◽  
Acl Injury Risk ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are multifactorial events that may be influenced by morphometric parameters. Associations between primary ACL injuries or graft ruptures and both femoral and tibial bony risk factors have been well described in the literature. Purpose: To determine values of femoral and tibial bony morphology that have been associated with ACL injuries in a reference population. Further, to define interindividual variations according to participant demographics and to identify the proportion of participants presenting at least 1 morphological ACL injury risk factor. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Computed tomography scans of 382 healthy participants were examined. The following bony ACL risk factors were analyzed: notch width index (NWI), lateral femoral condylar index (LFCI), medial posterior plateau tibial angle (MPPTA), and lateral posterior plateau tibial angle (LPPTA). The proportion of this healthy population presenting with at least 1 pathological ACL injury risk factor was determined. A multivariable logistic regression model was constructed to determine the influence of demographic characteristics. Results: According to published thresholds for ACL bony risk factors, 12% of the examined knees exhibited an intercondylar notch width <18.9 mm, 25% had NWI <0.292, 62% exhibited LFCI <0.67, 54% had MPPTA <83.6°, and 15% had LPPTA <81.6°. Only 14.4% of participants exhibited no ACL bony risk factors, whereas 84.5% had between 2 and 4 bony risk factors and 1.1% had all bony risk factors. The multivariate analysis demonstrated that only the intercondylar notch width ( P < .0001) was an independent predictor according to both sex and ethnicity; the LFCI ( P = .012) and MMPTA ( P = .02) were independent predictors according to ethnicity. Conclusion: The precise definition of bony anatomic risk factors for ACL injury remains unclear. Based on published thresholds, 15% to 62% of this reference population would have been considered as being at risk. Large cohort analyses are required to confirm the validity of previously described morphological risk factors and to define which participants may be at risk of primary ACL injury and reinjury after surgical reconstruction.

scholarly journals Determination of the Position of the Knee at the Time of an Anterior Cruciate Ligament Rupture for Male Versus Female Patients by an Analysis of Bone Bruises

2018 ◽  
Vol 46 (7) ◽  
pp. 1559-1565 ◽  
Author(s):  
Kwadwo A. Owusu-Akyaw ◽  
Sophia Y. Kim ◽  
Charles E. Spritzer ◽  
Amber T. Collins ◽  
Zoë A. Englander ◽  
...  
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Male And Female ◽  
Mri Scans ◽  
Internal Tibial Rotation ◽  
Anterior Cruciate ◽  
Tibial Translation

Background: The incidence of anterior cruciate ligament (ACL) ruptures is 2 to 4 times higher in female athletes as compared with their male counterparts. As a result, a number of recent studies have addressed the hypothesis that female and male patients sustain ACL injuries via different mechanisms. The efficacy of prevention programs may be improved by a better understanding of whether there are differences in the injury mechanism between sexes. Hypothesis/Purpose: To compare knee positions at the time of a noncontact ACL injury between sexes. It was hypothesized that there would be no differences in the position of injury. Study Design: Controlled laboratory study. Methods: Clinical T2-weighted magnetic resonance imaging (MRI) scans from 30 participants (15 male and 15 female) with a noncontact ACL rupture were reviewed retrospectively. MRI scans were obtained within 1 month of injury. Participants had contusions associated with an ACL injury on both the medial and lateral articular surfaces of the femur and tibia. Three-dimensional models of the femur, tibia, and associated bone bruises were created via segmentation on MRI. The femur was positioned relative to the tibia to maximize bone bruise overlap, thereby predicting the bone positions near the time of the injury. Flexion, valgus, internal tibial rotation, and anterior tibial translation were measured in the predicted position of injury. Results: No statistically significant differences between male and female patients were detected in the position of injury with regard to knee flexion ( P = .66), valgus ( P = .87), internal tibial rotation ( P = .26), or anterior tibial translation ( P = .18). Conclusion: These findings suggest that a similar mechanism results in an ACL rupture in both male and female athletes with this pattern of bone bruising. Clinical Relevance: This study provides a novel comparison of male and female knee positions at the time of an ACL injury that may offer information to improve injury prevention strategies.

scholarly journals Tentative age-related norms for high frequency electric bone conduction audiometry

1995 ◽  
Vol 42 (1) ◽  
Author(s):  
G. R. Voogt ◽  
H. S. Schoeman
Keyword(s):  
Medical Treatment ◽  
High Frequency ◽  
Bone Conduction ◽  
Clinical Applications ◽  
Male And Female ◽  
Female Patients ◽  
Age Related

From 172 male and female patients aged 7-71 years old and admitted in one month to a tuberculosis hospital, 150 had their highest audible electric bone conduction (EBC) frequency evaluated, prior to the commencement of any medical treatment. Various problems in establishing high frequency norms are discussed and from the results of this study tentative age-related highest frequency EBC norms are suggested. Possible clinical applications of evaluating the highest audible C frequency is suggested.

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