scholarly journals Effect of Age at Menarche on Anterior Cruciate Ligament Injury Incidence and Anterior Knee Laxity in Collegiate Athletes

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Andrew Froehle ◽  
Joseph Cox ◽  
Jedediah May ◽  
Kimberly Grannis ◽  
Dana Duren
Keyword(s):  
Injury Risk ◽  
Cruciate Ligament ◽  
Collegiate Athletes ◽  
Knee Laxity ◽  
Age At Menarche ◽  
Injury Incidence ◽  
Acl Injuries ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee

Female athletes suffer painful, costly, and career-limiting non-contact anterior cruciate ligament (ACL) injuries more often than males. Previous research suggests that pubertal neuromusculoskeletal development contributes to this sex-bias, but the manner in which variation in pubertal development affects injury risk within females is poorly understood. Age at menarche is a variable, significant pubertal developmental event, signaling the onset of estrogen cycling and affecting musculoskeletal development. Earlier menarche may increase injury risk, possibly by increasing anterior knee laxity through prolonged estrogen exposure. The purpose of this case-control study was to test the primary hypothesis that collegiate athletes with previous ACL injuries have earlier age at menarche than their uninjured peers, and to test the secondary hypothesis that earlier menarche is related to greater anterior knee laxity in injured and uninjured athletes. The study sample consisted of female NCAA Division-I varsity athletes (N=14 injured, N=120 uninjured). Outcome measures included: menstrual history and ACL injury details (injury age, activity at time of injury, contact vs. non-contact), assessed by questionnaire; and anterior knee laxity assessed by KT-1000 arthrometer. Correlation, t-tests, and regression analysis were used to test for associations between age at menarche, injury incidence, and knee laxity. Fourteen athletes reported ≥1 non-contact ACL injury, and had significantly earlier menarche than uninjured athletes (12.6±1.3 y vs. 13.4±1.4 y; P=0.05). Earlier menarche also significantly predicted injury status (Wald c2=7.43; Pb=-1.02±0.37; OR=0.36; 95% CI:0.17-0.75), but was not correlated with anterior knee laxity. Within injured athletes, however, laxity in the unaffected knee was significantly related to time since menarche (r2=0.79, Pr2=0.72, P

Assessing Laxity Characteristics of Hyperextension Knee in Healthy Young Females Using a Knee Ligament Arthrometer

2007 ◽  
Author(s):  
Hsiu-Chen Lin ◽  
Weng-Hang Lai ◽  
Chia-Ming Chang ◽  
Horng-Chaung Hsu
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Acl Injury ◽  
Male Athletes ◽  
Knee Ligament ◽  
Young Females ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee

Female athletes are more likely to sustain an anterior cruciate ligament (ACL) injury than male athletes. Previous study has showed that female individuals had larger anterior knee laxity than their male counterparts [1]. Researchers have also reported that knee laxity and hyperextension knee were a possible factor contributing to ACL injury [2]. Loudon showed that a person with hyperextension knee, either healthy or ACL-injured, had poorer proprioceptive control. Even more, ACL-injured subjects with hyperextension knee demonstrated a declined function of proprioception feedback loop and the ability to initiate protective reflexes [3].

scholarly journals Clinical Tests Can Be Used to Screen for Second Anterior Cruciate Ligament Injury in Younger Patients Who Return to Sport

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986300 ◽  
Author(s):  
Kate E. Webster ◽  
Julian A. Feller
Keyword(s):  
Anterior Cruciate Ligament ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Knee Laxity ◽  
Acl Injury ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Clinical Measures ◽  
Anterior Knee

Background: Younger athletes have high rates of second anterior cruciate ligament (ACL) injury. Return-to-sport criteria have been proposed to enable athletes to make a safe return, but they frequently lack validation. It is unclear whether commonly recorded clinical measures can help to identify high-risk athletes. Purpose: To explore the association between commonly recorded clinical outcome measures and second ACL injury in a young, active patient group. Study Design: Cohort study; Level of evidence, 2. Methods: Included in this study were 329 athletes (200 males, 129 females) younger than 20 years at the time of first primary ACL reconstruction surgery who had subsequently returned to sport participation. Clinical examination included range of knee motion (passive flexion and extension deficits), instrumented anterior knee laxity, and single- and triple-crossover hop for distance. Patients also completed the subjective International Knee Documentation Committee form. All measures were collected prospectively at a 12-month postoperative clinical review. Patients were evaluated for a minimum 3 years to determine the incidence of subsequent ACL injury. Results: A total of 95 patients (29%) sustained a second ACL injury following clinical assessment and return to sport. There were 50 graft ruptures and 45 contralateral ACL injuries. Patients with a flexion deficit of 5° had over 2 times the odds of sustaining a graft rupture (odds ratio, 2.3; P < .05), and patients with a side-to-side difference in anterior knee laxity of 3 mm or greater had over 2 times the odds of sustaining a contralateral ACL injury (odds ratio, 2.4; P < .05). Overall, 29% (94 of 329) of patients met the threshold for satisfactory function on all 6 clinical measures; these patients had a 33% reduction in the risk of sustaining a second ACL injury ( P = .05) as compared with those who did not meet all clinical thresholds. Conclusion: Clinical measures of knee flexion and stability may have utility to screen for and identify patients who are at greater risk for a second ACL injury in an already high-risk group (ie, age and activity level).

scholarly journals Association of Anterior Cruciate Ligament Width With Anterior Knee Laxity

2016 ◽  
Vol 51 (6) ◽  
pp. 460-465 ◽  
Author(s):  
Hsin-Min Wang ◽  
Sandra J. Shultz ◽  
Randy J. Schmitz
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Acl Injury ◽  
Resonance Imaging ◽  
Notch Angle ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee ◽  
Femoral Notch

Context: Greater anterior knee laxity (AKL) has been identified as an anterior cruciate ligament (ACL) injury risk factor. The structural factors that contribute to greater AKL are not fully understood but may include the ACL and bone geometry. Objective: To determine the relationship of ACL width and femoral notch angle to AKL. Design: Cross-sectional study. Setting: Controlled laboratory. Patients or Other Participants: Twenty recreationally active females (age = 21.2 ± 3.1 years, height = 1.66.1 ± 7.3 cm, mass = 66.5 ± 12.0 kg). Main Outcome Measure(s): Anterior cruciate ligament width and femoral notch angle were obtained with magnetic resonance imaging of the knee and AKL was assessed. Anterior cruciate ligament width was measured as the width of a line that transected the ACL and was drawn perpendicular to the Blumensaat line. Femoral notch angle was formed by the intersection of the line parallel to the posterior cortex of the femur and the Blumensaat line. Anterior knee laxity was the anterior displacement of the tibia relative to the femur (mm) at 130 N of an applied force. Ten participants' magnetic resonance imaging data were assessed on 2 occasions to establish intratester reliability and precision. Using stepwise backward linear regression, we examined the extent to which ACL width, femoral notch angle, and weight were associated with AKL. Results: Strong measurement consistency and precision (intraclass correlation coefficient [2,1] ± SEM) were established for ACL width (0.98 ± 0.3 mm) and femoral notch angle (0.97° ± 1.1°). The regression demonstrated that ACL width (5.9 ± 1.4 mm) was negatively associated with AKL (7.2 ± 2.0 mm; R2 = 0.22, P = .04). Femoral notch angle and weight were not retained in the final model. Conclusions: A narrower ACL was associated with greater AKL. This finding may inform the development of ACL injury-prevention programs that include components designed to increase ACL size or strength (or both). Future authors should establish which other factors contribute to greater AKL in order to best inform injury-prevention efforts.

scholarly journals Relationship of Anterior Cruciate Ligament Volume and T2* Relaxation Time to Anterior Knee Laxity

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712097998
Author(s):  
Hsin-Min Wang ◽  
Sandra J. Shultz ◽  
Scott E. Ross ◽  
Robert A. Henson ◽  
David H. Perrin ◽  
...  
Keyword(s):  
Relaxation Time ◽  
Cruciate Ligament ◽  
Relaxation Times ◽  
Knee Laxity ◽  
T2 Relaxation Time ◽  
T2 Relaxation ◽  
Acl Injuries ◽  
Structural Composition ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate

Background: High anterior knee laxity (AKL) has been prospectively identified as a risk factor for anterior cruciate ligament (ACL) injuries. Given that ACL morphometry and structural composition have the potential to influence ligamentous strength, understanding how these factors are associated with greater AKL is warranted. Hypothesis: Smaller ACL volumes combined with longer T2* relaxation times would collectively predict greater AKL. Study Design: Cross-sectional study; Level of evidence, 3. Methods: College-aged active male (n = 20) and female (n = 30) participants underwent magnetic resonance imaging (MRI) and AKL testing. T2-weighted MRI scans were used to assess ACL volumes, and T2* relaxation times were used to assess ACL structural composition. AKL was measured via a commercial knee arthrometer. Forward stepwise linear regression with sex and weight (first step; suppressor variables) as well as ACL volume and T2* relaxation time (second step; independent variables) was used to predict AKL (dependent variable). Results: After initially adjusting for sex and weight ( R 2 = 0.19; P = .006), smaller ACL volumes combined with longer T2* relaxation times collectively predicted greater AKL ( R 2 = 0.52; P < .001; R 2 Δ = 0.32; P Δ < .001). A smaller ACL volume was the primary predictor of greater AKL ( R 2 Δ = 0.28; P < .001), with a longer T2* relaxation time trending toward a significant contribution to greater AKL ( R 2 Δ = 0.04; P = .062). After adjusting for ACL volume and T2* relaxation time, sex (partial r = 0.05; P = .735) and weight (partial r = 0.05; P = .725) were no longer significant predictors. Conclusion: AKL was largely predicted by ACL volume and to a lesser extent by T2* relaxation time (and not a person’s sex and weight). These findings enhance our understanding of how AKL may be associated with a structurally weaker ACL. The current study presents initial evidence that AKL is a cost-effective and clinically accessible measure that shows us something about the structural composition of the ACL. As AKL has been consistently shown to be a risk factor for ACL injuries, work should be done to continue to investigate what AKL may tell a clinician about the structure and composition of the ACL.

scholarly journals Revision ACL Reconstruction - A retrospective failure analysis with a mean follow up of 35 months

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0030
Author(s):  
Lena Alm ◽  
Matthias Krause ◽  
Karl-Heinz Frosch ◽  
Ralph Akoto
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Knee Instability ◽  
Medial Knee ◽  
Risk Of Failure ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee

Aims and Objectives: While patients following primary anterior cruciate ligament (ACL) surgery show satisfying results, the outcome after revision ACL reconstruction (ACLR) seems to be less favourable. The purpose of this study was to evaluate the outcome of patients after revision ACLR. We hypothesize that peripheral knee instabilities and further concomitant lesions are risk factors for failure of revision ACLR. Furthermore, we hypothesize that peripheral stabilisation will reduce the risk of failure. Materials and Methods: Between 2013 and 2016, 111 patients with revision ACLR (revision surgery after primary ACL reconstruction) were included in the retrospective study. All patients were clinically examined with a minimum of 2 years after revision surgery (mean 35 months) and identified as “failed revision ACLR” (side-to-side difference greater than 5mm and/or pivot-shift grade 2/3) and “stable revision ACLR”. Multiple logistic regression modeling was used to evaluate whether certain predisposing factors were associated with increased odds of failure of the revision ACLR. Results: Failure after revision ACLR occurred in 14.5% (n=16) of the cases. Preoperative medial knee instability (n=36) was associated with failure of revision ACLR, thus patients had a 17 times greater risk of failure when medial knee instability was diagnosed preoperatively. Also, the risk of failure was reduced when patients had peripheral medial (n=24) and/ or antero-lateral stabilisation (n=51). Increased posterior tibial slope (PTS, n=11 greater than 12°) and high-grade anterior knee laxity (side-to-side-difference greater than 5 mm and/or pivot-shift grade 3, n=41) were associated with failed revision ACLR. Furthermore, patients had a 9 times greater risk of failure when they were obese (BMI greater than 30 kg/m2, n=30). Also, postoperative functional scores in comparison to preoperative scores were shown to be significantly higher (Lysholm 85±27 vs. 51±31.9, p=0.024; Tegner 6.5± 1.3 vs. 4± 2.6, p=0.015). Conclusion: Results following revision anterior cruciate ligament reconstruction (ACLR) are less favourable than primary ACLR. Peripheral medial knee instability, high-grade anterior knee laxity, increased PTS and high BMI are risk factors for failure in revision ACLR while additional medial and/or antero-lateral stabilisation reduces the risk of failure.

scholarly journals Slope-Correction Osteotomy with Lateral Extra-articular Tenodesis and Revision Anterior Cruciate Ligament Reconstruction Is Highly Effective in Treating High-Grade Anterior Knee Laxity

2020 ◽  
Vol 48 (14) ◽  
pp. 3478-3485
Author(s):  
Ralph Akoto ◽  
Lena Alm ◽  
Tobias Claus Drenck ◽  
Jannik Frings ◽  
Matthias Krause ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Knee Laxity ◽  
High Grade ◽  
Correction Osteotomy ◽  
Anterior Knee Laxity ◽  
Functional Scores ◽  
Slope Correction ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: Both an elevated posterior tibial slope (PTS) and high-grade anterior knee laxity are often present in patients who undergo revision anterior cruciate ligament (ACL) surgery, and these conditions are independent risk factors for ACL graft failure. Clinical data on slope-correction osteotomy combined with lateral extra-articular tenodesis (LET) do not yet exist. Purpose: To evaluate the outcomes of patients undergoing revision ACL reconstruction (ACLR) and slope-correction osteotomy combined with LET. Study Design: Case series; Level of evidence, 4. Methods: Between 2016 and 2018, we performed a 2-stage procedure: slope-correction osteotomy was performed first, and then revision ACLR in combination with LET was performed in 22 patients with ACLR failure and high-grade anterior knee laxity. Twenty patients (6 women and 14 men; mean age, 27.8 ± 8.6 years; range, 18-49 years) were evaluated, with a mean follow-up of 30.5 ± 9.3 months (range, 24-56 months), in this retrospective case series. Postoperative failure was defined as a side-to-side difference of ≥5 mm in the Rolimeter test and a pivot-shift grade of 2 or 3. Results: The PTS decreased from 15.3° to 8.9°, the side-to-side difference decreased from 7.2 to 1.1 mm, and the pivot shift was no longer evident in any of the patients. No patients exhibited revision ACLR failure and all patients showed good to excellent postoperative functional scores (mean ± SD: visual analog scale, 0.5 ± 0.6; Tegner, 6.1 ± 0.9; Lysholm, 90.9 ± 6.4; Knee injury and Osteoarthritis Outcome Score [KOOS] Symptoms, 95.2 ± 8.4; KOOS Pain, 94.7 ± 5.2; KOOS Activities of Daily Living, 98.5 ± 3.2; KOOS Function in Sport and Recreation, 86.8 ± 12.4; and KOOS Quality of Life, 65.4 ± 14.9). Conclusion: Slope-correction osteotomy in combination with LET is a safe and reliable procedure in patients with high-grade anterior knee laxity and a PTS of ≥12°. Normal knee joint stability was restored and good to excellent functional scores were achieved after a follow-up of at least 2 years.

scholarly journals The Influence of Age on the Effectiveness of Neuromuscular Training to Reduce Anterior Cruciate Ligament Injury in Female Athletes

2012 ◽  
Vol 41 (1) ◽  
pp. 203-215 ◽  
Author(s):  
Gregory D. Myer ◽  
Dai Sugimoto ◽  
Staci Thomas ◽  
Timothy E. Hewett
Keyword(s):  
Injury Risk ◽  
Knee Injury ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Acl Injury ◽  
Injury Incidence ◽  
Acl Injuries ◽  
Injury Reduction ◽  
Anterior Cruciate

Background: In female athletes, sports-related injuries to the anterior cruciate ligament (ACL) increase during adolescence and peak in incidence during the mid- to late teens. Although biomechanical investigations indicate that a potential window of opportunity exists for optimal timing for the initiation of integrative neuromuscular training (NMT) in young female athletes, the influence of the timing of initiation of these programs on the efficacy of ACL injury reduction has yet to be evaluated. Hypothesis/Purpose: The purpose of the current report was to systematically review and synthesize the scientific literature regarding the influence of age of NMT implementation on the effectiveness for reduction of ACL injury incidence. The hypothesis tested was that NMT would show a greater effect in younger populations. Study Design: Meta-analysis; Level of evidence 1a. Methods: Data were pooled from 14 clinical trials that met the inclusion criteria of (1) number of ACL injuries reported; (2) NMT program used; (3) female participants were included; (4) investigations used prospective, controlled trials; and (5) age of participants was documented or was obtainable upon contact with the authors. A meta-analysis with odds ratio (OR) was used to compare the ratios of ACL injuries between intervention and control groups among differing age categorizations. Results: A meta-analysis of the 14 included studies demonstrated significantly greater knee injury reduction in female athletes who were categorized in the preventive NMT group compared with those who were in the control group (OR: 0.54; 95% confidence interval [CI]: 0.35, 0.83). Lower ACL injuries in mid-teens (OR 0.28; CI: 0.18, 0.42) compared with late teens (OR 0.48; CI: 0.21, 1.07) and early adults (OR 1.01; CI: 0.62, 1.64) were found in participants undergoing NMT. Conclusion: The findings of this meta-analysis revealed an age-related association between NMT implementation and reduction of ACL incidence. Both biomechanical and the current epidemiological data indicate that the potential window of opportunity for optimized ACL injury risk reduction may be before the onset of neuromuscular deficits and peak knee injury incidence in female athletes. Specifically, it may be optimal to initiate integrative NMT programs during early adolescence, before the period of altered mechanics that increase injury risk.

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