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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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    Adjacent Joint Kinematics after Ankle Arthrodesis in Cadaveric Gait Simulation
    SAGE Publications ; 2016
    In:  Foot & Ankle Orthopaedics Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0004-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0004-
    Abstract: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis is an effective treatment for decreasing pain in patients with end-stage ankle arthritis. However, all patients with an ankle arthrodesis will eventually develop adjacent joint arthritis. The etiology of adjacent joint arthritis after ankle arthrodesis is not fully understood due to the difficulty of investigating these joints in vivo. Cadaveric simulation provides a unique capability of studying intrinsic foot and ankle joint mechanics. The objective of this study was to establish the effect of ankle arthrodesis on adjacent joint kinematics using cadaveric gait simulation. We hypothesized that adjacent joint motion of the hindfoot would increase after ankle arthrodesis. Methods: Four mid-tibia cadaveric specimens were potted and secured to a static mounting fixture about a six-degree of freedom robotic platform.(Figure 1A) The nine extrinsic ankle tendons were isolated and connected to linear actuators instrumented with load cells in series. During simulations, a force plate was moved relative to the stationary specimen through an inverse tibial kinematic path. Three-dimensional ankle and hindfoot kinematics were captured using a motion capture system. After ankle arthrodesis, kinematics were recorded using the same muscle force and kinematic inputs as the intact condition to determine how the hindfoot would behave when simulating normal gait. To assess the effect of ankle arthrodesis during simulated walking on adjacent joint kinematics, pre- and post-arthrodesis kinematics of the subtalar and talonavicular joint were directly compared along the stance phase and differences were assessed using two-tailed, paired Student’s t-tests with an alpha value set at p = 0.05. Results: Subtalar and talonavicular joint plantarflexion was greater during the early phase of stance in the ankle arthrodesis condition.(Figure 1B and 1C). Talonavicular joint motion also demonstrated greater dorsiflexion during late stance following ankle arthrodesis (Figure 1C). Ankle arthrodesis had no detectable effect on axial or coronal plane motion in adjacent joints of the hindfoot. Conclusion: This study reveals that sagittal plane motion in the hindfoot is increased following ankle arthrodesis. These results provide further insight into how motion is redistributed to adjacent joints after arthrodesis during gait. Such compensatory motions may be related to changes in contact mechanics in adjacent joints which can lead to degenerative changes.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011416S00049
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 3
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    Effect of Subtalar Arthrodesis on Gait Kinematics in the Setting of Total Ankle Arthroplasty : A Study of Cadaveric Gait Simulation
    SAGE Publications ; 2016
    In:  Foot & Ankle Orthopaedics Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0003-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0003-
    Abstract: Ankle Arthritis Introduction/Purpose: Patients undergoing total ankle arthroplasty (TAA) often have symptomatic adjacent joint arthritis and deformity. Adjunctive procedures are frequently indicated in this setting in an attempt to ensure a stable and plantigrade ankle and hindfoot postoperatively. Although subtalar arthrodesis can effectively address a degenerative hindfoot, it may also place abnormal stress on the TAA, leading to premature failure. The objective of this study was to determine the effect of subtalar arthrodesis on TAA and adjacent joint kinematics using cadaveric gait simulation. We hypothesized that differences in ankle and talonavicular joint kinematics would be observed between TAA specimens with and without subtalar arthrodesis. Methods: Three mid-tibia cadaveric specimens (all female, average age at death: 48) with neutral foot alignment and no history of lower extremity trauma or surgery were tested in a robotic gait simulator. Each tibia was secured to a static mounting fixture about a six-degree of freedom robotic platform (Figure 1A). During simulations, a force plate was moved relative to the stationary specimen through an inverse tibial kinematic path based on standardized in vivo data. Salto Talaris total ankle prostheses were implanted (Tornier, Inc., Bloomington, MN) by a foot and ankle fellowship trained orthopaedic surgeon. Gait simulation was then performed. Each specimen then underwent in situ subtalar arthrodesis via fluoroscopically guided screw placement and subsequent gait analysis. The kinematics of TAA and TAA with subtalar arthrodesis during simulated walking were then compared using two-tailed, paired Student’s t-tests with an alpha value set at p = 0.05. Results: Analyses revealed that kinematics differed between specimens with TAA and those with TAA and subtalar arthrodesis (Figure 1B). During mid-stance, less ankle plantarflexion was observed in specimens with TAA and subtalar arthrodesis, as compared to those with isolated TAA. This difference was statistically significant (p 〈 0.05). With regard to axial motion in the ankle, significantly less external rotation was observed in early and mid-stance in specimens with TAA + subtalar arthrodesis (p 〈 0.05). Talonavicular kinematics also differed between cohorts (Figure 1B). In early and late stance, significantly decreased inversion was observed in specimens with subtalar arthrodesis (p 〈 0.05). And in early stance, talonavicular joint adduction was significantly diminished in the TAA + subtalar arthrodesis specimens, as compared to those with isolated TAA (p 〈 0.05). Conclusion: Via cadaveric gait simulation, our study describes the kinematic effects of subtalar arthrodesis on TAA. When TAA is performed in the setting of subtalar arthrodesis, both ankle sagittal and axial plane motion are altered, as are coronal and axial plane motion in the talonavicular joint. Because current clinical literature remains inconclusive on this relationship, additional work must be performed to better delineate the biomechanical and clinical sequelae of TAA performed with subtalar arthrodesis.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011416S00038
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 4
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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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  • 5
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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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  • 6
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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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  • 7
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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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  • 8
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    Ankle and Hindfoot Kinematics After Total Ankle Arthroplasty in Cadaveric Gait Simulation
    SAGE Publications ; 2016
    In:  Foot & Ankle Orthopaedics Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0002-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0002-
    Abstract: Ankle Arthritis. Introduction/Purpose: Total ankle arthroplasty (TAA) is an effective treatment option for end-stage ankle arthritis. However, with reports on long-term survivorship of current implant designs still anticipated in the literature, current research has focused on assessing prosthetic function and predicting potential failure mechanisms. Cadaveric gait simulation is a valuable tool for investigating the effects of surgical techniques on foot and ankle biomechanics. The objective of this study was to assess the effect of TAA on ankle and hindfoot kinematics using cadaveric gait simulation. We hypothesized that joint motion would be altered by the change in the articular constraint associated with joint replacement. Methods: Three mid-tibia cadaveric specimens were secured to a static mounting fixture about a six-degree of freedom robotic platform. A force plate was moved relative to the stationary specimen through an inverse tibial kinematic path calculated from in vivo data. Target tendon force profiles were applied to the nine extrinsic ankle tendons by linear actuators instrumented with load cells. (Figure 1A). Ankle and hindfoot kinematics were measured from reflective markers attached to bones via surgical pins. TAA was performed using the Salto Talaris prosthesis (Bloomington, MN). After replacing the ankle joint, foot and ankle kinematics were directly measured using the same kinematic inputs and muscle force as the intact condition. To assess the effect of TAA on joint kinematics, pre- and post-TAA motions were directly compared throughout the stance phase, and differences were assessed using two-tailed, paired Student’s t-tests with an alpha value set at p = 0.05. Results: Analyses revealed that ankle joint transverse plane motion was affected by TAA, with significantly greater talar internal rotation during the middle portion of stance after joint replacement (Figure 1B). In contrast, no differences were present in ankle joint sagittal and coronal plane motion between the intact and TAA condition. Dorsiflexion was greater in the subtalar joint after TAA during early stance. Similarly, there was greater dorsiflexion in the talonavicular joint during mid-stance in the TAA condition compared to the intact condition. There were no differences observed in the coronal or axial plane in either the subtalar or talonavicular joint after TAA. Conclusion: This study revealed that the talus underwent greater internal rotation during the weight acceptance portion of gait after TAA. The ankle joint however behaved similarly with respect to sagittal and coronal plane motion throughout stance after TAA. Compensatory motion however was noted in the subtalar and talonavicular joints, with greater dorsiflexion present in both joints during stance after TAA. This abstract represents an early subset of an ongoing study; smaller yet clinically important differences may still be present, and may be detected as more specimens are completed.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011416S00021
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 9
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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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  • 10
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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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