Pfeiffer, Thomas R; Burnham, Jeremy M; Hughes, Jonathan D; Kanakamedala, Ajay C; Herbst, Elmar; Popchak, Adam; Shafizadeh, Sven; Irrgang, James J; Debski, Richard E; Musahl, Volker
An Increased Lateral Femoral Condyle Ratio Is a Risk Factor for Anterior Cruciate Ligament Injury.
The purpose of this study was to examine the relationship between distal femoral morphology and anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) failure, and contralateral ACL injury. It was hypothesized that increased posterior femoral condylar depth, quantified as the lateral femoral condyle ratio, would correlate with increased risk of primary ACL injuries, ACLR failures, and contralateral ACL injuries.The charts of consecutive patients who underwent arthroscopic knee surgery at an academic medical center from 2012 to 2016 with minimum follow-up of 24 months were retrospectively reviewed. Patients were stratified into 4 groups: (1) a control group of patients with no ACL injury, (2) patients with primary ACL injury, (3) patients with failed ACLR, and (4) patients with previous ACL injury and subsequent contralateral ACL injury. With use of lateral radiographs, the ratio of posterior femoral condylar depth to total condylar length was defined as the lateral femoral condyle ratio. Differences between study groups were identified with use of analysis-of-variance (ANOVA) and post-hoc testing with significance set at p< 0.05. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff for detecting increased risk of ACL injury.Two hundred patients met the inclusion criteria. The mean lateral femoral condyle ratios (and standard deviations) were 61.2% ± 2.4% in the control group, 64.2% ± 3.8% in the primary ACL injury group, 64.4% ± 3.6% in the failed ACLR group, and 66.9% ± 4.3% in the contralateral ACL injury group. Patients who had a primary ACL injury, failed ACLR, or contralateral ACL injury had significantly higher ratios compared with the control group (p< 0.008). ROC curve analysis demonstrated that a lateral femoral condyle ratio of>63% was associated with an increased risk for ACL injury, with a sensitivity of 77% and a specificity of 72%.The data from this study show that increased posterior femoral condylar depth, quantified as the lateral femoral condyle ratio, is associated with an increased risk of ACL injury, including primary and contralateral ACL injuries. The data from this study may help clinicians to identify patients at a greater risk of ACL injury.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.