title: Geometric Risk Factors Associated With Noncontact Anterior Cruciate Ligament Graft Rupture.
abstract: Anterior cruciate ligament (ACL) graft rupture occurs at a high rate, especially in young athletes. The geometries of the tibial plateau and femoral intercondylar notch are risk factors for first-time ACL injury; however, little is known about the relationship between these geometries and risk of ACL graft rupture.
  
  
  
  The geometric risk factors for noncontact graft rupture are similar to those previously identified for first-time noncontact ACL injury, and sex-specific differences exist.
  
  
  
  Case-control study; Level of evidence, 3.
  
  
  
  Eleven subjects who suffered a noncontact ACL graft rupture and 44 subjects who underwent ACL reconstruction but did not experience graft rupture were included in the study. Using magnetic resonance imaging, the geometries of the tibial plateau subchondral bone, articular cartilage, meniscus, tibial spines, and femoral notch were measured. Risk factors associated with ACL graft rupture were identified using Cox regression.
  
  
  
  The following were associated with increased risk of ACL graft injury in males: increased posterior-inferior-directed slope of the articular cartilage in the lateral tibial plateau measured at 2 locations (hazard ratio [HR] = 1.50, P = .029; HR = 1.39, P = .006), increased volume (HR = 1.45, P = .01) and anteroposterior length (HR = 1.34, P = .0023) of the medial tibial spine, and increased length (HR = 1.18, P = .0005) and mediolateral width (HR = 2.19, P = .0004) of the lateral tibial spine. In females, the following were associated with increased risk of injury: decreased volume (HR = 0.45, P = .02) and height (HR = 0.46, P = .02) of the medial tibial spine, decreased slope of the lateral tibial subchondral bone (HR = 0.72, P = .01), decreased height of the posterior horn of the medial meniscus (HR = 0.09, P = .001), and decreased intercondylar notch width at the anterior attachment of the ACL (HR = 0.72, P = .02).
  
  
  
  The geometric risk factors for ACL graft rupture are different for males and females. For females, a decreased femoral intercondylar notch width and a decreased height of the posterior medial meniscus were risk factors for ACL graft rupture that have also been found to be risk factors for first-time injury. There were no risk factors in common between ACL graft injury and first-time ACL injury for males.
authors: Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA.
authors: James G
authors: JG
authors: Levins
authors: Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA.
authors: Daniel R
authors: DR
authors: Sturnick
authors: Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA.
authors: Erin C
authors: EC
authors: Argentieri
authors: Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA.
authors: Mack
authors: M
authors: Gardner-Morse
authors: Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA.
authors: Pamela M
authors: PM
authors: Vacek
authors: Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA.
authors: Michael J
authors: MJ
authors: Desarno
authors: Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA.
authors: Timothy W
authors: TW
authors: Tourville
authors: Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA.
authors: James R
authors: JR
authors: Slauterbeck
authors: Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont, USA bruce.beynnon@uvm.edu.
authors: Bruce D
authors: BD
authors: Beynnon
mesh_terms: D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D016022:Case-Control Studies; D005269:Femur / Q000033:anatomy & histology; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology; D012307:Risk Factors; D012421:Rupture / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D012727:Sex Characteristics; D013977:Tibia / Q000033:anatomy & histology; D019737:Transplants / Q000293:injuries* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: ACL; biomechanics; injury prevention; knee