Objective: A multi-factorial combination of predictors may increase ACL injury risk in athletes. The objective of this twin case series was to examine these risk factors to identify commonalities in risk factors that predisposed female fraternal twins to ACL injury.
Methods: Female twins in high-risk sports were prospectively measured prior to an injury for neuromuscular control using 3-dimensional motion analysis during landing, hamstrings and quadriceps muscular strength on a dynamometer and joint laxity suing a modified Beighton Horan index and a Compu-KT arthrometer. Intraoperative measures of femoral intercondylar notch width were recorded during ACL reconstruction.
Findings: Abduction angles were increased at one knee in both of the twin sister athletes relative to uninjured controls both at initial contact and at maximum displacement during landing. The twin female athletes that went on to ACL injury also demonstrated decreased peak knee flexion motion at both knees than uninjured females during landing. The twin athletes also had increased joint laxity and decreased hamstrings to quadriceps (H/Q) torque ratios compared to controls. Femoral intercondylar notch widths were also below the control mean in the twin siblings.
Conclusions: Prescreened mature female twins that subsequently suffered ACL injury demonstrated multiple potential risk factors including: increased knee abduction angles, decreased knee flexion angles, increased general joint laxity, decreased H/Q ratios and femoral intercondylar notch width.