Background Anterior cruciate ligament (ACL) reconstruction incidence has increased substantially in the past 25 years. Recently, there has been a focus on knee morphology as a contributor to ACL injury risk. The purpose of this study was to systematically review the literature to assess the influence of knee morphology on ACL injury. Methods In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, Embase, and MEDLINE were searched in September 2017 for studies reporting on knee morphology and ACL injury. The search was updated in June 2018. The following inclusion criteria were used: English language; full text available; Level-I, II, or III evidence; human studies; and skeletally mature patients. Results After systematically screening 6,208 studies, 65 studies met the inclusion/exclusion criteria. Three additional studies were identified in the search update, for a total of 68 studies comprising 5,834 ACL-injured knees. Intercondylar notch stenosis, most commonly defined by an "A-shaped" notch, decreased notch width, or decreased notch width index, was the most commonly reported femoral morphological risk factor for ACL injury. Increased femoral condylar offset ratio (>63%) and decreased condylar radius of curvature also were associated with an increased risk of ACL injury. Increased medial and lateral tibial slopes were the most commonly reported tibial risk factors. A smaller tibial eminence, reduced ACL size, and poor tibiofemoral congruity were also associated with increased injury risk. Conclusions Intercondylar notch stenosis, variations in sagittal condylar shape, increased tibial slope, reduced tibial eminence size, poor tibiofemoral congruity, and reduced ACL size are substantial risk factors for ACL injury. In future research, it would be valuable to identify a slope beyond which slope correction should be performed concomitantly with ACL reconstruction, and to determine whether an optimal relationship of notch size to graft size exists. To achieve optimal outcomes, the osseous morphological risk factors should be considered in individualized anatomic ACL reconstructions. Level of evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Knee Morphological Risk Factors for Anterior Cruciate Ligament Injury: A Systematic Review.

Purpose. To test if diameter of normal anterior cruciate ligament (ACL) can be measured by ultrasound (US), to see if there is a relationship between smaller ACL diameter and ACL injury, and to assess agreement between radiologists in measuring ACL diameter in cases and matched controls. Materials and Methods. In this ethics committee-approved study, maximum diameter of ACL near tibial insertion site was measured by static and dynamic US study in 25 normal contralateral knees of subjects who suffered noncontact ACL injury and in 25 matched control subjects. Results. ACL was visualized as a thick linear hypoechoic band inserted approximately 11 mm caudal to the tibial plateau and the intercondylar eminence. Maximum diameter of contralateral ACL near tibial insertion site among injured subjects was significantly smaller than in noninjured subjects (0.62 ± 0.07 cm versus 0.81 ± 0.06 cm; ). In the regression analysis, the diameter of ACL near tibial insertion site was found significantly proportional to body weight and not significantly associated to height, gender, and age. Conclusion. Diameter of normal ACL near tibial insertion site can be measured by US and the maximum diameter is significantly smaller among subjects with noncontact ACL injury. US is a promising modality that can be used as an excellent screening test to detect subjects especially aspiring athletes prone to ACL injury. Very strong agreement was observed between radiologists in measuring ACL diameter.

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Smaller anterior cruciate ligament diameter is a predictor of subjects prone to ligament injuries: an ultrasound study.

Bilateral ACL rupture is a relatively uncommon injury with an incidence of 2-4%. Most bilateral ACL rupture occurs at two different times, but few cases of single-staged bilateral ACL ruptures have also been reported. There have been reports of both single-staged, and two-staged reconstruction of bilateral ACL ruptures in the literature but without a clear consensus. We present a series of five bilateral ACL rupture cases managed by single-staged arthroscopic ACL reconstruction, using quadrupled hamstring grafts. All of them were young males, with an average age of 26.8 years (Range: 19-39 years). Three out of five of these cases (60%) had sustained the injury to both the knees simultaneously while playing sports. All the five patients had generalized joint laxity with significant hyperextension of their knees. All the ten knees (in five patients) were clinically stable, at their last follow-ups. None of the knees had any early or late complications. A single-staged bilateral ACL reconstruction is a safe, reproducible, and cost-effective procedure for patients with a bilateral ACL deficient knee, in experienced hands.

Bilateral simultaneous anterior cruciate ligament reconstruction: A case series and review of the literature.

Poster: "ECR 2015 / B-1207 / Smaller volume of anterior cruciate ligament increases the risk of anterior cruciate ligament injury: a MRI based case-control study" by: "P. S. Mahajan1, N. Al Moosawi2, Y. S. Al Nahedh2; 1Doha/QA, 2Kuwait City/KW"

Smaller volume of anterior cruciate ligament increases the risk of anterior cruciate ligament injury: a MRI based case-control study

Objective: Research reports regarding the value of femoral notch width index (NWI) in predicting anterior cruciate ligament injury are conflicting. This study examined the relationship between the NWI and anterior cruciate ligament (ACL) injury in a Kuwaiti population. Design: Retrospective case control study Setting: Jaber Al Ahmad Armed Forces Hospital, Kuwait Subjects: Three hundred and fifty-five adult patients Intervention: Multiplanar MRI sequences were performed using a 1.5T GE machine with the patient’s knee in an extended position Main Outcome Measures: The femoral notch and the distal condylar width were measured. Patients with normal ACL were used as control and those with a complete or partial tear of ACL were chosen as case group. Independent samples Student’s t-test was used to compare the means. Results: We found no significant difference in the mean NWI in patients with (0.296) and without (0.300) an ACL tear (p > 0.05). In addition, there was no significant difference in the frequency of ACL tears in patients with and without critical notch stenosis (p > 0.05). Conclusion: We did not find any association between narrow intercondylar notch width and ACL tears.

N. M. Al-Moosawi

Papers

MRI Evaluation of Femoral Intercondylar Notch Width Index in Cases with and without Anterior Cruciate Ligament Injuries. A Retrospective Study