title: Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk.
abstract: BACKGROUND
  While body mass index (BMI), a modifiable parameter, and knee morphology, a nonmodifiable parameter, have been identified as risk factors for anterior cruciate ligament (ACL) rupture, the interaction between them remains unknown. An understanding of this interaction is important because greater compressive axial force (perhaps due to greater BMI) applied to a knee that is already at an increased risk because of its geometry, such as a steep lateral posterior tibial slope, could further increase the probability of ACL injury.
  
  
  OBJECTIVE
  To quantify the relationship between BMI and select knee morphological parameters as potential risk factors for ACL injury.
  
  
  METHODS
  Case-control study; Level of evidence, 3.
  
  
  METHODS
  Sagittal knee magnetic resonance imaging (MRI) files from 76 ACL-injured and 42 uninjured subjects were gathered from the University of Michigan Health System's archive. The posterior tibial slope (PTS), middle cartilage slope (MCS), posterior meniscus height (PMH), and posterior meniscus bone angle (MBA) in the lateral compartment were measured using MRI. BMI was calculated from demographic data. The association between the knee structural factors, BMI, and ACL injury risk was explored using univariate and multivariate logistic regression.
  
  
  RESULTS
  PTS (P= .043) and MCS (P= .037) significantly predicted ACL injury risk. As PTS and MCS increased by 1°, odds of sustaining an ACL injury increased by 12% and 13%, respectively. The multivariate logistic regression analysis, which included PTS, BMI centered around the mean (cBMI), and their interaction, showed that this interaction predicted the odds of ACL rupture (P= .050; odds ratio, 1.03). For every 1-unit increase in BMI from the average that is combined with a 1° increase in PTS, the odds of an ACL tear increased by 15%.
  
  
  CONCLUSIONS
  An increase in BMI was associated with increased risk of ACL tear in the presence of increased lateral posterior tibial slope. Larger values of PTS or MCS were associated with an increased risk of ACL tear.
authors.affiliation: Medical School, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Bojicic
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Mélanie L
authors.initials: ML
authors.lastname: Beaulieu
authors.affiliation: Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Imaizumi Krieger
authors.affiliation: Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA.; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Ashton-Miller
authors.affiliation: MedSport, Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Wojtys
keywords: ACL; BMI; anatomy; injury prevention; knee; ligament