Multivariable analysis of anatomic risk factors for anterior cruciate ligament injury in active individuals

  • Xianyue Shen
  • Jianlin Xiao
  • Yuhui Yang
  • Tong Liu
  • Shangjun Chen
  • Zhongli Gao
  • Jianlin ZuoEmail author
Arthroscopy and Sports Medicine



The aim of the present study was to compare the morphometric differences between patients with or without anterior cruciate ligament (ACL) injury, and identify the anatomic risk factors associated with ACL injury in active individuals.


The knee joint magnetic resonance images (MRI) of 100 subjects were included in this study. Data from the ACL-injured group (50 patients) and matched controls (50 subjects) were obtained from the same hospital. These data were analyzed by univariable analysis or multivariable conditional logistic regression analysis to examine the effects of the following variables on the risk of suffering ACL injury for the first time: TT-TG distance, medial and lateral tibial slope, intercondylar notch width and depth, femur condylar width, lateral femoral condylar depth, notch width index (NWI), notch shape index (NSI), notch depth index (NDI), and cross-sectional area (CSA).


In the univariable analysis, the ACL-injured group had a larger TT-TG distance, increased medial and lateral tibial slope, narrower intercondylar notch width, deeper lateral femoral condylar depth, lesser NWI and NSI, and CSA when compared with the control group (P < 0.05). However, there were no significant between-group differences in intercondylar notch depth (P = 0.174), femur condylar width (P = 0.797), and NDI (P = 0.436). The multivariable analysis revealed that TT-TG distance [odds ratio (OR) = 1.37, 95% CI = 1.04–1.81, P = 0.028], medial tibial slope (OR = 1.30, 95% CI = 1.02–1.66, P = 0.036) and NWI (OR = 0.46, 95% CI = 0.24–0.91, P = 0.025) had significant multivariable associations with the sole independent risk of ACL injury.


Larger TT-TG distance, increased MTS, and lesser NWI are independent anatomic risk factors for active individuals with ACL injury.

Level of evidence

Case-control study; Level of Evidence, III.


Anterior cruciate ligament injury Tibial plateau TT-TG distance MRI Risk factors 



There was no funding for this study.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Xianyue Shen
    • 1
  • Jianlin Xiao
    • 1
  • Yuhui Yang
    • 2
  • Tong Liu
    • 1
  • Shangjun Chen
    • 3
  • Zhongli Gao
    • 1
  • Jianlin Zuo
    • 1
    Email author
  1. 1.Department of OrthopedicsChina-Japan Union Hospital of Jilin UniversityChangchunPeople’s Republic of China
  2. 2.Department of OrthopedicsGuangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences)GuangzhouPeople’s Republic of China
  3. 3.Norman Bethune Medical SchoolJilin UniversityChangchunPeople’s Republic of China

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