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  • 1
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    Geometric profile of the tibial plateau cartilage surface is associated with the risk of non‐contact anterior cruciate ligament injury
    Wiley ; 2014
    In:  Journal of Orthopaedic Research Vol. 32, No. 1 ( 2014-01), p. 61-68
    Details
    In: Journal of Orthopaedic Research, Wiley, Vol. 32, No. 1 ( 2014-01), p. 61-68
    Abstract: The purpose of this study was to determine if geometry of the articular surfaces of the tibial plateau is associated with non‐contact anterior cruciate ligament (ACL) injury. This was a longitudinal cohort study with a nested case–control analysis. Seventy‐eight subjects who suffered a non‐contact ACL tear and a corresponding number of controls matched by age, sex, and sport underwent 3 T MRI of both knees. Surface geometry of the tibial articular cartilage was characterized with polynomial equations and comparisons were made between knees on the same person and between ACL‐injured and control subjects. There was no difference in surface geometry between the knees of the control subjects. In contrast, there were significant differences in the surface geometry between the injured and normal knees of the ACL‐injured subjects, suggesting that the ACL injury changed the cartilage surface profile. Therefore, comparisons were made between the uninjured knees of the ACL‐injured subjects and the corresponding knees of their matched controls and this revealed significant differences in the surface geometry for the medial ( p   〈  0.006) and lateral ( p   〈  0.001) compartments. ACL‐injured subjects tended to demonstrate a posterior–inferior directed orientation of the articular surface relative to the long axis of the tibia, while the control subjects were more likely to show a posterior–superior directed orientation. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:61–68, 2014.
    Type of Medium: Online Resource
    ISSN: 0736-0266 , 1554-527X
    URL: Issue
    URL: Article
    DOI: 10.1002/jor.v32.1
    DOI: 10.1002/jor.22434
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 2
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    Geometric Characteristics of the Knee Are Associated With a Noncontact ACL Injury to the Contralateral Knee After Unilateral ACL Injury in Young Female Athletes
    SAGE Publications ; 2017
    In:  The American Journal of Sports Medicine Vol. 45, No. 14 ( 2017-12), p. 3223-3232
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 45, No. 14 ( 2017-12), p. 3223-3232
    Abstract: Contralateral anterior cruciate ligament (CACL) injury after recovery from a first-time ACL rupture occurs at a high rate in young females; however, little is known about the risk factors associated with bilateral ACL trauma. Hypothesis: The geometric characteristics of the contralateral knee at the time of the initial ACL injury are associated with risk of suffering a CACL injury in these female athletes. Study Design: Case-control study; Level of evidence, 3. Methods: Sixty-two female athletes who suffered their first noncontact ACL injury while participating in sports at the high school or college level were identified, and geometry of the femoral notch, ACL, tibial spines, tibial subchondral bone, articular cartilage surfaces, and menisci of the contralateral, uninjured, knee was characterized in 3 dimensions. We were unable to contact 7 subjects and followed the remaining 55 until either a CACL injury or an ACL graft injury occurred or, if they were not injured, until the date of last contact (mean, 34 months after their first ACL injury). Cox regression was used to identify risk factors for CACL injury. Results: Ten (18.2%) females suffered a CACL injury. Decreases of 1 SD in femoral intercondylar notch width (measured at its outlet and anterior attachment of the ACL) were associated with increases in the risk of suffering a CACL injury (hazard ratio = 1.88 and 2.05, respectively). Likewise, 1 SD decreases in medial-lateral width of the lateral tibial spine, height of the medial tibial spine, and thickness of the articular cartilage located at the posterior region of the medial tibial compartment were associated with 3.59-, 1.75-, and 2.15-fold increases in the risk of CACL injury, respectively. Conclusion: After ACL injury, subsequent injury to the CACL is influenced by geometry of the structures that surround the ACL (the femoral notch and tibial spines). This information can be used to identify individuals at increased risk for CACL trauma, who might benefit from targeted risk-reduction interventions.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546517735091
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 3
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    Geometric Risk Factors Associated With Noncontact Anterior Cruciate Ligament Graft Rupture
    SAGE Publications ; 2016
    In:  The American Journal of Sports Medicine Vol. 44, No. 10 ( 2016-10), p. 2537-2545
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 44, No. 10 ( 2016-10), p. 2537-2545
    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. Hypothesis: 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. Study Design: Case-control study; Level of evidence, 3. Methods: 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. Results: 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). Conclusion: 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.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546516657525
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 4
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    Combined Injury to the ACL and Lateral Meniscus Alters the Geometry of Articular Cartilage and Meniscus Soon After Initial Trauma
    Wiley ; 2020
    In:  Journal of Orthopaedic Research Vol. 38, No. 4 ( 2020-04), p. 759-767
    Details
    In: Journal of Orthopaedic Research, Wiley, Vol. 38, No. 4 ( 2020-04), p. 759-767
    Abstract: Combined injury to the anterior cruciate ligament (ACL) and meniscus is associated with earlier onset and increased rates of post‐traumatic osteoarthritis compared with isolated ACL injury. However, little is known about the initial changes in joint structure associated with these different types of trauma. We hypothesized that trauma to the ACL and lateral meniscus has an immediate effect on morphometry of the articular cartilage and meniscus about the entire tibial plateau that is more pronounced than an ACL tear without meniscus injury. Subjects underwent magnetic resonance imaging scanning soon after injury and prior to surgery. Those that suffered injury to the ACL and lateral meniscus underwent changes in the lateral compartment (increases in the posterior–inferior directed slopes of the articular cartilage surface, and the wedge angle of the posterior horn of the meniscus) and medial compartment (the cartilage‐to‐bone height decreased in the region located under the posterior horn of the meniscus, and the thickness of cartilage increased and decreased in the mid and posterior regions of the plateau, respectively). Subjects that suffered an isolated ACL tear did not undergo the same magnitude of change to these articular structures. A majority of the changes in morphometry occurred in the lateral compartment of the knee; however, change in the medial compartment of the knee with a normal appearing meniscus also occurred. Statement of clinical significance: Knee injuries that involve combined trauma to the ACL and meniscus directly affect both compartments of the knee, even if the meniscus and articular cartilage appears normal upon arthroscopic examination. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:759‐767, 2020
    Type of Medium: Online Resource
    ISSN: 0736-0266 , 1554-527X
    URL: Issue
    URL: Article
    DOI: 10.1002/jor.v38.4
    DOI: 10.1002/jor.24519
    Language: English
    Publisher: Wiley
    Publication Date: 2020
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  • 5
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    A Sex-Stratified Multivariate Risk Factor Model for Anterior Cruciate Ligament Injury
    Journal of Athletic Training/NATA ; 2015
    In:  Journal of Athletic Training Vol. 50, No. 10 ( 2015-10-01), p. 1094-1096
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 50, No. 10 ( 2015-10-01), p. 1094-1096
    Type of Medium: Online Resource
    ISSN: 1062-6050
    URL: Article
    DOI: 10.4085/1062-6050-50.10.05
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2015
    detail.hit.zdb_id: 2070051-9
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  • 6
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    Increased Slope of the Lateral Tibial Plateau Subchondral Bone Is Associated With Greater Risk of Noncontact ACL Injury in Females but Not in Males : A Prospective Cohort Study With a Nested, Matched Case-Control Analysis
    SAGE Publications ; 2014
    In:  The American Journal of Sports Medicine Vol. 42, No. 5 ( 2014-05), p. 1039-1048
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 42, No. 5 ( 2014-05), p. 1039-1048
    Abstract: There is an emerging consensus that increased posterior-inferior directed slope of the subchondral bone portion of the tibial plateau is associated with increased risk of suffering an anterior cruciate ligament (ACL) injury; however, most of what is known about this relationship has come from unmatched case-control studies. These observations need to be confirmed in more rigorously designed investigations. Hypothesis: Increased posterior-inferior directed slope of the medial and lateral tibial plateaus are associated with increased risk of suffering a noncontact ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: In sum, 176 athletes competing in organized sports at the college and high school levels participated in the study: 88 suffering their first noncontact ACL injury and 88 matched controls. Magnetic resonance images were acquired, and geometry of the subchondral bone portion of the tibial plateau was characterized on each athlete bilaterally by measuring the medial and lateral tibial plateau slopes, coronal tibial slope, and the depth of the medial tibial plateau. Comparisons between knees of the same person were made with paired t tests, and associations with injury risk were assessed by conditional logistic regression analysis of ACL-injured and control participants. Results: Controls exhibited side-to-side symmetry of subchondral bone geometry, while the ACL-injured athletes did not, suggesting that the ACL injury may have changed the subchondral bone geometry. Therefore, the uninjured knees of the ACL-injured athletes and the corresponding limbs of their matched controls were used to assess associations with injury risk. Analyses of males and females as a combined group and females as a separate group showed a significant association between ACL injury risk and increased posterior-inferior directed slope of the lateral tibial plateau slope. This relationship was not apparent when males were analyzed as a group. Multivariate analyses indicated that these results were independent of the medial tibial plateau slope, coronal tibial slope, and depth of the medial tibial plateau, which were not associated with ACL injury. Conclusion: There is a 21.7% increased risk of noncontact ACL injury with each degree increase of the lateral tibial plateau slope among females but not among males. The medial tibial plateau slope, coronal tibial slope, and depth of the medial tibial plateau were not associated with risk of injury for females or males.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546514523721
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
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  • 7
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    Multivariate Analysis of the Risk Factors for First-Time Noncontact ACL Injury in High School and College Athletes : A Prospective Cohort Study With a Nested, Matched Case-Control Analysis
    SAGE Publications ; 2016
    In:  The American Journal of Sports Medicine Vol. 44, No. 6 ( 2016-06), p. 1492-1501
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 44, No. 6 ( 2016-06), p. 1492-1501
    Abstract: Multivariate analysis that identifies the combination of risk factors associated with anterior cruciate ligament (ACL) trauma is important because it provides insight into whether a variable has a direct causal effect on risk or an indirect effect that is mediated by other variables. It can also reveal risk factors that might not be evident in univariate analyses; if a variable’s effect is moderated by other variables, its association with risk may be apparent only after adjustment for the other variables. Most important, multivariate analyses can identify combinations of risk factors that are more predictive of risk than individual risk factors. Hypothesis: A diverse combination of risk factors predispose athletes to first-time noncontact ACL injury, and these relationships are different for male and female athletes. Study Design: Case-control study; Level of evidence, 3. Methods: Athletes competing in organized sports at the high school and college levels participated in this study. Data from injured subjects (109 suffering an ACL injury) and matched controls (227 subjects) from the same athletic team were analyzed with multivariate conditional logistic regression to examine the effects of combinations of variables (demographic characteristics, joint laxity, lower extremity alignment, strength, and personality traits) on the risk of suffering their first ACL injury and to construct risk models. Results: For male athletes, increases in anterior-posterior displacement of the tibia relative to the femur (knee laxity), posterior knee stiffness, navicular drop, and a decrease in standing quadriceps angle were jointly predictive of suffering an ACL injury. For female athletes the combined effects of having a parent who had suffered an ACL injury and increases in anterior-posterior knee laxity and body mass index were predictive of ACL injury. Conclusion: Multivariate models provided more information about ACL injury risk than individual risk factors. Both male and female risk models included increased anterior-posterior knee laxity as a predictor of ACL injury but were otherwise dissimilar.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546516634682
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 8
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    Articular cartilage thickness changes differ between males and females 4 years following anterior cruciate ligament reconstruction
    Wiley ; 2022
    In:  Journal of Orthopaedic Research Vol. 40, No. 1 ( 2022-01), p. 65-73
    Details
    In: Journal of Orthopaedic Research, Wiley, Vol. 40, No. 1 ( 2022-01), p. 65-73
    Abstract: Anterior cruciate ligament injury and reconstruction (ACLR) affects articular cartilage thickness profiles about the tibial, femoral, and patellar surfaces; however, it's unclear whether the magnitudes of change in cartilage thickness, as well as the locations and areas over which these changes occur, differ between males and females. This is important to consider as differences exist between the sexes with regard to knee biomechanics, patellofemoral pain, and anatomic alignment, which influence risk of an index and repeated injury. Subjects underwent ACLR with a bone‐patella tendon‐bone autograft. At 4‐year follow‐up, they had asymptomatic knees; however, significant ACL injured‐to‐contralateral normal knee differences in articular cartilage thickness values were observed. Both thickening and thinning of cartilage occurred about the tibiofemoral and patellofemoral joints, relative to matched control subjects with normal knees. Further, the location of the areas and magnitudes of thickening and thinning were different between females and males. Thickening (swelling) of articular cartilage is an early finding associated with the onset of posttraumatic osteoarthritis (PTOA). Therefore, the increases in cartilage thickness that were observed in this cohort may represent early signs of the onset of PTOA that occur prior to the patient developing symptoms and radiographic evidence of this disease. The different locations of areas that underwent a change in cartilage thicknesses between males and females suggest that each sex responds differently to knee ligament trauma, reconstruction, rehabilitation, and return to activity, and indicates that sex‐specific analysis should be utilized in studies of PTOA.
    Type of Medium: Online Resource
    ISSN: 0736-0266 , 1554-527X
    URL: Issue
    URL: Article
    DOI: 10.1002/jor.v40.1
    DOI: 10.1002/jor.25142
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 9
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    Tibial articular cartilage and meniscus geometries combine to influence female risk of anterior cruciate ligament injury
    Wiley ; 2014
    In:  Journal of Orthopaedic Research Vol. 32, No. 11 ( 2014-11), p. 1487-1494
    Details
    In: Journal of Orthopaedic Research, Wiley, Vol. 32, No. 11 ( 2014-11), p. 1487-1494
    Abstract: Tibial plateau subchondral bone geometry has been associated with the risk of sustaining a non‐contact ACL injury; however, little is known regarding the influence of the meniscus and articular cartilage interface geometry on risk. We hypothesized that geometries of the tibial plateau articular cartilage surface and meniscus were individually associated with the risk of non‐contact ACL injury. In addition, we hypothesized that the associations were independent of the underlying subchondral bone geometry. MRI scans were acquired on 88 subjects that suffered non‐contact ACL injuries (27 males, 61 females) and 88 matched control subjects that were selected from the injured subject's teammates and were thus matched on sex, sport, level of play, and exposure to risk of injury. Multivariate analysis of the female data revealed that increased posterior‐inferior directed slope of the middle articular cartilage region and decreased height of the posterior horn of the meniscus in the lateral compartment were associated with increased risk of sustaining a first time, non‐contact ACL injury, independent of each other and of the slope of the tibial plateau subchondral bone. No measures were independently related to risk of non‐contact ACL injury among males. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1487–1494, 2014.
    Type of Medium: Online Resource
    ISSN: 0736-0266 , 1554-527X
    URL: Issue
    URL: Article
    DOI: 10.1002/jor.v32.11
    DOI: 10.1002/jor.22702
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 10
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    Relationship Between the Risk of Suffering a First-Time Noncontact ACL Injury and Geometry of the Femoral Notch and ACL : A Prospective Cohort Study With a Nested Case-Control Analysis
    SAGE Publications ; 2014
    In:  The American Journal of Sports Medicine Vol. 42, No. 8 ( 2014-08), p. 1796-1805
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 42, No. 8 ( 2014-08), p. 1796-1805
    Abstract: The morphometric characteristics of the anterior cruciate ligament (ACL) and the femoral intercondylar notch within which it resides have been implicated as risk factors for injuries to this important stabilizer of the knee. Prior research has produced equivocal results with differing methodologies, and consequently, it is unclear how these characteristics affect the injury risk in male and female patients. Hypothesis: The morphometric characteristics of the ACL and femoral intercondylar notch are individually and independently associated with the risk of suffering a noncontact ACL injury, and these relationships are different in male and female patients. Study Design: Case-control study; Level of evidence, 3. Methods: Magnetic resonance imaging scans of the bilateral knees were obtained on 88 case-control pairs (27 male, 61 female) matched for age, sex, and participation on the same sports team. Patients had suffered a grade III, first-time, noncontact ACL tear. The femoral notch width at 4 locations, the thickness of the bony ridge at the anteromedial outlet of the femoral notch, the femoral notch volume, ACL volume, and ACL cross-sectional area were measured. Results: Multivariate analysis of combined data from male and female patients revealed that decreased ACL volume (odds ratio [OR], 0.829), decreased femoral notch width (OR, 0.700), and increased bony ridge thickness at the anteromedial outlet of the femoral notch (OR, 1.614) were significant independent predictors of an ACL injury. Separate analyses of male and female patients indicated that the femoral notch ridge may be more strongly associated with a risk in female patients, while ACL volume is more strongly associated with a risk in male patients. However, statistical analysis performed with an adjustment for body weight strengthened the association between ACL volume and the risk of injuries in female patients. Conclusion: Morphometric features of both the ACL and femoral notch combine to influence the risk of suffering a noncontact ACL injury. When included together in a multivariate model that adjusts for body weight, the effects of the morphometric measurements are similar in male and female patients. If body weight is not taken into consideration, ACL volume is not associated with a risk in female patients.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546514534182
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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