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Patellofemoral morphology is associated with ACL rupture in pediatric patients: a quantitative MRI-based case-control
Hasan Bulut1,2, Furkan Özdem3, Osman Yağız Atlı4
1Department of Pediatric Radiology, Ankara Etlik City Hospital, Ankara, Turkey. hsn_blt89@hotmail.com.
Objective:
Anterior cruciate ligament (ACL) tears are becoming increasingly common in children. Morphological characteristics of the patellofemoral joint may predispose to ACL tears. In this study, we investigated whether patellofemoral morphological characteristics are associated with ACL tears in children.
Materials And Methods:
We retrospectively reviewed knee magnetic resonance imaging (MRI) scans of 120 patients under the age of 18. The patient and control groups were divided into 60 patients with ACL tears and 60 age- and gender-matched control groups without ACL tears, following the same exclusion criteria. Continuous variables were compared using Student's t-test or Mann-Whitney U test, and categorical variables using the Chi-square or Fisher's exact test, as appropriate. Factors associated with ACL injury were evaluated using univariate and multivariate logistic regression analysis.
Results:
Trochlear dysplasia was more frequent in the ACL group compared to the control group (35% vs. 5%, p < 0.001) and was mostly mild (Dejour type A). Patients with ACL tears also had a higher sulcus angle and a lower trochlear depth, with a tendency toward lateral slope and facet asymmetry (all p < 0.001). The TT-TG distance was significantly increased (p = 0.029). While patellar morphology differed between groups (p = 0.016), patellar slope did not show a significant difference (p = 0.085).
Conclusion:
Significant associations were identified between patellofemoral morphology and ACL rupture in pediatric patients. Assessment of these morphological features on routine MRI may provide additional clinical information, although prospective multicenter studies are needed to clarify their clinical relevance.
