Researchers from multiple centers have performed a systematic review of the literature in order to determine the extent to which knee morphology affects anterior cruciate ligament (ACL) injury.
How Much Does Morphology Affect ACL Treatment?
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Co-author Volker Musahl, M.D., with the University of Pittsburgh Medical Center Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, described the objectives of this new study to OTW: “Many studies have been published on the impact of various bony morphological parameters on ACL injury risk. A detailed understanding of variations in bony morphology is essential to identifying risk factors and performing individualized, value based, anatomic ACLR [anterior cruciate ligament reconstruction]. Therefore, we synthesized the available literature associating various bony morphological parameters with increased ACL injury risk.”
The study, “Knee Morphological Risk Factors for Anterior Cruciate Ligament Injury: A Systematic Review,” appears in The Journal of Bone and Joint Surgery.
Co-author Sean Meredith, M.D., an assistant professor of Orthopaedics at the University of Maryland School of Medicine in Baltimore, told OTW, “This systematic review identified several frequently reported bony morphological parameters that increase risk for ACL injury: narrow intercondylar notch (A-shaped notch, decreased notch width, decreased notch width index), increased femoral condylar offset, decreased condylar radius of radius of curvature, and increased tibial slope (both medial and lateral). Less commonly reported bony morphological parameters associated with ACL injury include smaller tibial eminence, decreased ACL size, and poor tibiofemoral congruity (by a variety of measurements).”
It’s important to respect “Mother Nature,” say these surgeons. Co-author Steve Bayer, M.D., who just completed medical school at the University of Pittsburgh, summarized the study to OTW, “Based on our systematic review there are many open questions regarding bony morphology that warrant future research, such as the value of certain ACL prevention programs or return to sport programs, slope correcting osteotomies, double bundle ACLR or lateral extra-articular tenodesis (LET) procedures. The main goal of our research is to provide individual patient specific, value-based treatment while respecting nature and patient individual anatomic- and bony morphological parameters.”
“From this systematic review, there are many bony morphological risk factors for ACL injury. Further research is needed to determine how to best implement new knowledge into ACL injury prevention programs and ACL treatment to ultimately improve outcome for patients.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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