Kamaci S., Kolaç U. C., Arzu U., Avcı Yön H., Bingol I., Ata E. U., ...More
ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE, vol.13, no.9_suppl3, pp.1-5, 2025 (SCI-Expanded, Scopus)
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Publication Type:
Article / Article
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Volume:
13
Issue:
9_suppl3
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Publication Date:
2025
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Doi Number:
10.1177/2325967125s00298
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Journal Name:
ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE
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Journal Indexes:
Scopus, Science Citation Index Expanded (SCI-EXPANDED), CINAHL, EMBASE, Directory of Open Access Journals
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Page Numbers:
pp.1-5
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Hacettepe University Affiliated:
Yes
Abstract
Objectives:
Anterior cruciate ligament (ACL) tears are prevalent among the pediatric population, often leading to knee instability, reduced activity levels, and early onset of osteoarthritis. The incidence of ACL reconstruction (ACLR) in children and adolescents has risen significantly over the last decade. While various intrinsic and extrinsic factors have been implicated in increasing the risk of ACL tears, the role of patellofemoral parameters has not been comprehensively evaluated in a large cohort. This study investigates the association between patellofemoral abnormalities and the incidence of ACL tears in a pediatric cohort. We hypothesize that children with patellofemoral abnormalities have a higher rate of ACL tears compared to those with normal patellofemoral anatomy.
Methods:
A retrospective analysis of 443 pediatric patients who underwent ACLR from 2016 to 2022, using data from the ‘e-Nabiz’ digital personal health record system was conducted. Patellofemoral parameters, including trochlear dysplasia, TT-TG distance, sulcus angle, and Caton-Deschamps Index, were evaluated from imaging studies. A control group of 443 age- and sex-matched individuals from the normal population was used for comparison. A random matched sample of 50 patients (25 ACLR, 25 Controls) was used to determine interrater reliability between two examiners. The agreement between raters in terms of numerical variables was evaluated with the Spearman correlation coefficient, and Intraclass correlation coefficient (ICC). To compare differences between groups, either a two-sided Mann-Whitney U test was applied for continuous variables, while Yates correction for continuity chi-square were employed for categorical variables. The cut-off points for TT-TG and Sulcus angle were determined by Receiver Operating Characteristic Curve (ROC) analysis. Cut-off values were calculated with the Youden Index. Univariate analysis and multiple binary logistic regression were performed to identify risk factors for anterior cruciate ligament rupture.All statistical analyses were evaluated at p < 0.05.
Results:
A total of 886 skeletally immature patients (443 ACLR – 443 Control) who underwent ACLR were included in the study. The ICC values for the agreement between observers in terms of numerical variables are above 0.80, indicating excellent reliability. Accordingly, there was a good agreement beyond chance for the Dejour classification between observer-1 and observer-2, who made the evaluation (κW=0.914),
Table 1-Figure 3
. The TT-TG distance in the ACLR group was significantly higher than in the control group (median 10 mm, SD: 9 – 12.3 mm vs 9.9 mm, SD: 9.2 – 10.5 mm, p = 0.002). The mean sulcus angle was significantly greater in the ACLR group compared to the control group ( median 141 (132 – 152) vs. 135 (130-140), p < 0.001). For the Caton-Deschamps index, there was no significant difference between the ACLR group and the control group for the CDI (1.07 ± 0.1 for both groups, p = 0.778), The prevalence of trochlear dysplasia was significantly higher in the ACLR group (148 cases, 91,9%) compared to the control group (13 cases, 8,1%), p-value of <0.001,
Table 2
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The cut-off points for TT-TG and Sulcus angle were determined by ROC and Youden index were 11.75 mm and 142.5 degrees, respectively. Indicating that values over the cut-off are associated with an increased risk for ACL rupture,
Table 3
. The model created to define the factors associated with ACL tear showed that, the risk of ACL tear is 4.951 times higher in individuals with a TT-TG value above 11.75 compared to those with a value below 11.75. The risk of anterior cruciate ligament tear is 3.271 times higher in individuals with a sulcus value greater than 142.5 compared to those with a value below 142.5. The risk of ACL tear is 5.375 times higher in individuals with trochlear dysplasia values compared to those without dysplasia,
Table 4
. Based on the Hosmer-Lemeshow test result, the model is determined to have a good fit to the data. To assess the goodness of fit of the established model, a correct classification rate of 72.10% and an AUC value of 0.73 were obtained,
Figure 4 and 5
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Conclusions:
Patellofemoral abnormalities, including increased TT-TG distance, greater sulcus angle, and prevalence of trochlear dysplasia, are significantly associated with pediatric ACL tears. These findings suggest that assessing patellofemoral parameters could be crucial in predicting and potentially preventing ACL injuries in children. Future preventive strategies should consider these parameters to reduce the risk of ACL tears in the pediatric population.