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. 2025 Jun;53(7):1596-1605.
doi: 10.1177/03635465251334120. Epub 2025 Apr 28.

Morphological Risk Factors for Pediatric Anterior Cruciate Ligament Tears and Tibial Spine Fractures

Chang Ho Shin  1   2   3 , Akbar N Syed  4   3 , Morgan E Swanson  4   3 , J Todd R Lawrence  4   5   3 , Soroush Baghdadi  6   3 , Aristides I Cruz Jr  7   3 , Henry B Ellis Jr  8   3 , Peter D Fabricant  9   3 , Daniel W Green  9   3 , Alicia Kerrigan  10   3 , Julia Kirby  11   3 , Mininder Kocher  12   3 , Indranil V Kushare  13   3 , R Jay Lee  14   3 , James P MacDonald  15   3 , Scott D McKay  13   3 , Shital N Parikh  16   3 , Neeraj M Patel  17   3 , Yi-Meng Yen  12   3 , Gregory A Schmale  18   3 , Kevin G Shea  19   3 , R Justin Mistovich  20   21   3 , Theodore J Ganley  4   5   3
Affiliations

Morphological Risk Factors for Pediatric Anterior Cruciate Ligament Tears and Tibial Spine Fractures

Chang Ho Shin et al. Am J Sports Med. 2025 Jun.

Abstract

Background: Both tibial spine fractures (TSFs) and anterior cruciate ligament (ACL) tears result in functional loss of knee stability. Nonetheless, it remains unclear why some patients sustain ACL tears, whereas others have TSFs.

Purpose: To identify the common morphological risk factors for pediatric ACL tears and TSFs and to determine the morphological differences between them using multiplanar reconstruction of magnetic resonance imaging (MRI).

Study design: Cohort study; Level of evidence, 3.

Methods: Age- and sex-matched participants (159 total [53 ACL tears, 53 TSFs, and 53 controls]) aged <18 years who visited a pediatric tertiary-care center for ACL tears, TSFs, or anterior knee pain from March 2009 to April 2023 were included. Each group comprised 41 male and 12 female participants. Data on demographic characteristics and estimated bone age based on the knee MRI atlas were retrospectively collected, and various knee morphological parameters were evaluated using multiplanar reconstruction of MRI. Parameters showing significant differences among the 3 groups were selected as independent variables for multivariable multinomial logistic regression analysis, with the groups as dependent variables.

Results: The mean chronological age at the time of MRI was 13.2 ± 2.3 years. Height, weight, body mass index, bone age, articular medial tibial slope, and bony medial tibial slope did not differ among the groups. Articular lateral tibial slope was independently associated with the occurrence of both ACL tears (relative risk ratio [RRR], 1.42 [95% confidence interval (CI), 1.16-1.74]; P = .001) and TSFs (RRR, 1.33 [95% CI, 1.10-1.62]; P = .004). A high notch width index was a protective factor against ACL tears (RRR, 0.86 [95% CI, 0.77-0.96]; P = .006) but not against TSFs (RRR, 1.01 [95% CI, 0.91-1.12]; P = .848).

Conclusion: A high articular lateral tibial slope was a common risk factor for ACL tears and TSFs. Patients with ACL tears had a narrower intercondylar notch than those with TSFs and controls.

Keywords: anterior cruciate ligament; notch width; pediatric sports medicine; tibial slope; tibial spine fracture.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: S.B. has received education payments from Arthrex. H.B.E. has received education payments from Pylant Medical and hospitality payments from Stryker. P.D.F. has received consulting fees from WishBone Medical. D.W.G. has received consulting fees from OrthoPediatrics, royalties from Arthrex and OrthoPediatrics, and hospitality payments from Synthes. I.V.K. has received education payments from MedInc of Texas. R.J.L. has received education payments from Arthrex. J.P.M. has received grants from DJO. S.D.M. has received education payments from MedInc of Texas. S.N.P. has received consulting fees from Pfizer. N.M.P. has received education payments from Medwest Associates. Y.-M.Y. has received education payments from Kairos Surgical and consulting fees from Smith+Nephew. G.A.S. has received education payments from Summit Surgical. K.G.S. has received education payments from Evolution Surgical. R.J.M. has received consulting fees from OrthoPediatrics, hospitality payments from Globus Medical and Medical Device Business Services, and service payments from Philips Electronics North America. T.J.G. has received research support from AlloSource and Vericel; has received education payments from Arthrex, Paladin Technology Solutions, and Liberty Surgical; and is a paid associate editor for The American Journal of Sports Medicine. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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