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  1. Renato Andrade1,2,3,
  2. Sebastiano Vasta4,
  3. Rogério Pereira1,2,3,5,
  4. Ana Leal1,2,6,
  5. Luís Silva1,2,
  6. Cátia Saavedra1,2,
  7. Ricardo Bastos1,2,
  8. Rui Rocha1,2,
  9. Alberto Monteiro1,2,
  10. Nuno Sevivas1,2,
  11. Rocco Papalia4,
  12. João Espregueira-Mendes1,2,7,8,9,10
  1. 1Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal
  2. 2Dom Henrique Research Centre, Porto, Portugal
  3. 3Faculty of Sports, University of Porto, Porto, Portugal
  4. 4Campus Biomedico, University of Rome, Rome, Italy
  5. 5University Fernando Pessoa, Porto, Portugal
  6. 6CMEMS Center for MicroElectroMechanical Systems, Mechanical Engineering Department, University of Minho, Braga, Portugal
  7. 7Faculty of Medicine, University of Porto, Porto, Portugal
  8. 8Orthopaedics Department of Minho University, Braga, Portugal
  9. 93B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Braga/Guimarães, Portugal
  10. 10ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal


    Background Tibiofemoral bone morphology has been proposed as a potential risk factor for anterior cruciate ligament (ACL) rupture, with recent increasing interest in the lateral femoral condyle.

    Objective Investigate several tibiofemoral bone morphology measurements as risk factors for rupturing the ACL.

    Design Retrospective case–control study.

    Setting Clinical setting.

    Patients (or Participants) 200 ACL-ruptured patients and 200 normal subjects without history of previous knee injuries, with a mean age of 24 years old.

    Main Outcome Measurements Presence or not of ACL rupture.

    Assessment of Risk Factors Radiographic measurements of the distal epiphysis/diaphysis of the femur and proximal epiphysis of the tibia were performed, including: anteroposterior-flattened surface of the femur's lateral condyle; femur's diaphysis anteroposterior distance; anteroposterior distance of the femur's lateral condyle; height of the femur's lateral condyle; anteroposterior distance of the tibial plateaus; tibial slope. In addition, three morphological ratios were calculated.

    Results Most of the bone morphological parameters were different between genders (P<0.001). Similarly, there were significant differences between ACL-ruptured and control subjects (P<0.001), either for total sample or subgrouped by gender. Logistic regression model showed that 5 bone morphological parameters were significantly associated with ACL rupture (AUC=0.967, P<0.001). The calculated ratios showed significant accuracy in identifying individuals with higher risk of sustaining an ACL injury (P<0.001).

    Conclusions Several tibiofemoral bone morphology radiographic measurements are associated with an ACL rupture. Morphological ratios based on these measurements seem to identify individuals at higher risk of sustaining an ACL rupture. These findings might contribute to health counselling on level of sports participation. Moreover, it may help to identify individuals who may benefit the most from secondary prevention programs, where the risk of new injury is very high.

    • Injury

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