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Diagnostic Value of Condylar Distance Asymmetry Relative to the Femoral and Tibial Anatomic Axes in Anterior Cruciate
Enver İpek1, Mehmet Akif Köse1, Abdurrahman Demirhan1
1Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Background:
Anatomical risk factors for anterior cruciate ligament (ACL) injury remain incompletely defined, particularly those reflecting combined tibiofemoral geometry.
Purpose:
To determine whether the tibial axis-condylar distance difference (T-ACD) and femoral ACD (F-ACD) are independently associated with ACL rupture and to compare their performance with other morphometric indices.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
In this single-center study, 63 magnetic resonance imaging (MRI)-confirmed ACL-ruptured knees were age- and sex-matched to 62 control knees from 2022 to 2024. Weightbearing anteroposterior radiographs provided T-ACD and F-ACD; true lateral radiographs and MRI yielded posterior tibial slope (PTS), lateral tibial height (LTH), medial tibial plateau depth (MTD), lateral femoral condylar index (LFCI), LFC height-to-depth ratio (LFC-H/D) and notch width index (NWI). Two blinded observers performed all measurements and repeated them after 3 weeks; intra- and interobserver reliability were calculated. Multivariate logistic regression with intraclass correlation coefficient (ICC) and receiver operating characteristic analysis assessed independent associations and discriminative ability.
Results:
ACL rupture knees were younger than controls (27.3 ± 7.9 vs 30.3 ± 7.6 years; P = .04); sex, side, and body mass index were comparable (P > .05). Intraobserver ICC was 0.86 to 0.94 and interobserver ICC measured 0.83 to 0.92. T-ACD, F-ACD, LTH, and LFCI were significantly greater in ruptured knees (P < .001; Cohen d≥ 0.67). A T-ACD ≥4.5 mm conferred an odds ratio of 1.84/mm (95% CI, 1.34-2.53) and showed good discrimination (area under the curve [AUC] = 0.858). The composite model (T-ACD + LTH + LFCI) achieved excellent accuracy (optimism-corrected AUC = 0.957; Nagelkerke R 2 = 0.83). PTS, LFC-H/D, MTD, and NWI were not significant predictors (P > .05).
Conclusion:
Our study showed that coronal-plane condylar height asymmetry, particularly T-ACD, along with LTH and LFCI, may serve as potentially useful morphometric markers for ACL rupture risk. If confirmed by external validation, identification of high-risk morphometry on routine radiographs and MRI may help guide targeted neuromuscular training and injury prevention programs in at-risk individuals.
