scholarly journals Association of Anterior Cruciate Ligament Width With Anterior Knee Laxity

2016 ◽  
Vol 51 (6) ◽  
pp. 460-465 ◽  
Author(s):  
Hsin-Min Wang ◽  
Sandra J. Shultz ◽  
Randy J. Schmitz

Context: Greater anterior knee laxity (AKL) has been identified as an anterior cruciate ligament (ACL) injury risk factor. The structural factors that contribute to greater AKL are not fully understood but may include the ACL and bone geometry. Objective: To determine the relationship of ACL width and femoral notch angle to AKL. Design: Cross-sectional study. Setting: Controlled laboratory. Patients or Other Participants: Twenty recreationally active females (age = 21.2 ± 3.1 years, height = 1.66.1 ± 7.3 cm, mass = 66.5 ± 12.0 kg). Main Outcome Measure(s): Anterior cruciate ligament width and femoral notch angle were obtained with magnetic resonance imaging of the knee and AKL was assessed. Anterior cruciate ligament width was measured as the width of a line that transected the ACL and was drawn perpendicular to the Blumensaat line. Femoral notch angle was formed by the intersection of the line parallel to the posterior cortex of the femur and the Blumensaat line. Anterior knee laxity was the anterior displacement of the tibia relative to the femur (mm) at 130 N of an applied force. Ten participants' magnetic resonance imaging data were assessed on 2 occasions to establish intratester reliability and precision. Using stepwise backward linear regression, we examined the extent to which ACL width, femoral notch angle, and weight were associated with AKL. Results: Strong measurement consistency and precision (intraclass correlation coefficient [2,1] ± SEM) were established for ACL width (0.98 ± 0.3 mm) and femoral notch angle (0.97° ± 1.1°). The regression demonstrated that ACL width (5.9 ± 1.4 mm) was negatively associated with AKL (7.2 ± 2.0 mm; R2 = 0.22, P = .04). Femoral notch angle and weight were not retained in the final model. Conclusions: A narrower ACL was associated with greater AKL. This finding may inform the development of ACL injury-prevention programs that include components designed to increase ACL size or strength (or both). Future authors should establish which other factors contribute to greater AKL in order to best inform injury-prevention efforts.

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986300 ◽  
Author(s):  
Kate E. Webster ◽  
Julian A. Feller

Background: Younger athletes have high rates of second anterior cruciate ligament (ACL) injury. Return-to-sport criteria have been proposed to enable athletes to make a safe return, but they frequently lack validation. It is unclear whether commonly recorded clinical measures can help to identify high-risk athletes. Purpose: To explore the association between commonly recorded clinical outcome measures and second ACL injury in a young, active patient group. Study Design: Cohort study; Level of evidence, 2. Methods: Included in this study were 329 athletes (200 males, 129 females) younger than 20 years at the time of first primary ACL reconstruction surgery who had subsequently returned to sport participation. Clinical examination included range of knee motion (passive flexion and extension deficits), instrumented anterior knee laxity, and single- and triple-crossover hop for distance. Patients also completed the subjective International Knee Documentation Committee form. All measures were collected prospectively at a 12-month postoperative clinical review. Patients were evaluated for a minimum 3 years to determine the incidence of subsequent ACL injury. Results: A total of 95 patients (29%) sustained a second ACL injury following clinical assessment and return to sport. There were 50 graft ruptures and 45 contralateral ACL injuries. Patients with a flexion deficit of 5° had over 2 times the odds of sustaining a graft rupture (odds ratio, 2.3; P < .05), and patients with a side-to-side difference in anterior knee laxity of 3 mm or greater had over 2 times the odds of sustaining a contralateral ACL injury (odds ratio, 2.4; P < .05). Overall, 29% (94 of 329) of patients met the threshold for satisfactory function on all 6 clinical measures; these patients had a 33% reduction in the risk of sustaining a second ACL injury ( P = .05) as compared with those who did not meet all clinical thresholds. Conclusion: Clinical measures of knee flexion and stability may have utility to screen for and identify patients who are at greater risk for a second ACL injury in an already high-risk group (ie, age and activity level).


Author(s):  
Hsiu-Chen Lin ◽  
Weng-Hang Lai ◽  
Chia-Ming Chang ◽  
Horng-Chaung Hsu

Female athletes are more likely to sustain an anterior cruciate ligament (ACL) injury than male athletes. Previous study has showed that female individuals had larger anterior knee laxity than their male counterparts [1]. Researchers have also reported that knee laxity and hyperextension knee were a possible factor contributing to ACL injury [2]. Loudon showed that a person with hyperextension knee, either healthy or ACL-injured, had poorer proprioceptive control. Even more, ACL-injured subjects with hyperextension knee demonstrated a declined function of proprioception feedback loop and the ability to initiate protective reflexes [3].


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