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Bone morphology and morphometry of the lateral femoral condyle is a risk factor for ACL injury

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to investigate the influence of the knee lateral compartment bony morphology and morphometry on risk of sustaining an anterior cruciate ligament (ACL) injury.

Methods

A total of 400 age and sex-matched patients (200 ACL-ruptured and 200 ACL-intact) were included. The lateral femoral and tibial bone morphology and morphometric parameters were measured on knee lateral radiographs, taken at 30° of knee flexion with overlapping of the femoral condyles. Radiographic measurements included: anteroposterior-flattened surface of the femur’s lateral condyle (XY); femur’s diaphysis anteroposterior distance (A); anteroposterior distance of the femur’s lateral condyle (B); height of the femur’s lateral condyle (C); anteroposterior distance of the tibial plateaus (AB); tibial slope. In addition, three morphological ratios were calculated: B/AB; B/XY; XY/AB (Porto ratio).

Results

Most of bone morphological parameters were different between genders (P < 0.05). ACL-ruptured female subjects showed statistical significant smaller condyle heights (C), smaller distances of the flattened surface of the distal femoral condyle (XY), smaller tibial plateau anteroposterior distances (AB), and higher XY/AB ratio (P < 0.05). ACL-ruptured male subjects had statistical significant smaller condyle height (C), anteroposterior distance of the femur’s lateral condyle (B), tibial plateau anteroposterior distances (AB), and tibial slope (P < 0.05). Multivariate logistic regression model showed that five morphological parameters (A, XW, XY, XZ, and AB) were significantly associated with ACL rupture (AUC = 0.967, P < 0.001). Calculated ratios (XY/AB; B/AB; B/XY) showed a significant accuracy in identifying individuals with ACL injury (P < 0.001).

Conclusions

The most important finding of this study was that the calculated ratios (XY/AB; B/AB; B/XY) showed a significant accuracy in identifying the individuals with and without an ACL injury. Within this line, a longer flat surface of the lateral femoral condyle or higher Porto ratio (XY/AB) is associated with a lower the risk of ACL injury. Moreover, when considering the combination of five primary bone morphology and morphometric parameters (A, XW, XY, XZ, and AB), the accuracy in identifying these individuals was excellent (AUC = 0.967). These findings may contribute to injury risk assessment, sports participation, and injury prevention counseling and surgical planning refining by identifying high-risk patients who would benefit from the addition of associated procedures to the anatomic ACL reconstruction aiming the improvement of knee stability and decrease the risk of further injuries.

Level of evidence

III, case–control study.

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Author information

Authors and Affiliations

  1. Orthopaedics and Trauma Surgery Department, University Campus Bio-Medico of Rome, Rome, Italy

    Sebastiano Vasta & Rocco Papalia

  2. Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence, Porto, Portugal

    Renato Andrade, Rogério Pereira, Ricardo Bastos & João Espregueira-Mendes

  3. Faculty of Sports, University of Porto, Porto, Portugal

    Renato Andrade & Rogério Pereira

  4. Dom Henrique Research Centre, Porto, Portugal

    Renato Andrade, Rogério Pereira, Ricardo Bastos & João Espregueira-Mendes

  5. Faculty of Health Sciences, University of Fernando Pessoa, Porto, Portugal

    Rogério Pereira

  6. Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil

    Ricardo Bastos

  7. Orthopaedic and Trauma Surgery Residency program, Università degli Studi di Milano Statale, Rome, Italy

    Antonino Giulio Battaglia

  8. 3B’s Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal

    João Espregueira-Mendes

  9. ICVS/3B’s-PT Government Associate Laboratory, Braga/Guimarães, Portugal

    João Espregueira-Mendes

  10. Orthopaedics Department, University of Minho, Braga, Portugal

    João Espregueira-Mendes

Authors
  1. Sebastiano Vasta
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  2. Renato Andrade
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  7. João Espregueira-Mendes
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Correspondence to João Espregueira-Mendes.

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The authors declare that they have no conflict of interest.

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The authors declare that there was no funding of this study.

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This was a retrospective study and a ethics committee approval was not required.

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This article does not contain any studies with animals performed by any of the authors.

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Vasta, S., Andrade, R., Pereira, R. et al. Bone morphology and morphometry of the lateral femoral condyle is a risk factor for ACL injury. Knee Surg Sports Traumatol Arthrosc 26, 2817–2825 (2018). https://doi.org/10.1007/s00167-017-4761-x

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  • DOI: https://doi.org/10.1007/s00167-017-4761-x

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