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ORIGINAL ARTICLE
Year : 2018  |  Volume : 18  |  Issue : 2  |  Page : 67-70

The anthropometric measurements as predisposing factor for noncontact anterior cruciate ligament injury in middle-aged women


1 Department of Orthopedic Surgery, King Saud University Faculty of Medicine, Riyadh, Saudi Arabia
2 Department of Orthopedic Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Web Publication16-Oct-2018

Correspondence Address:
Rashed Mohammed Bin Khidhr
Khidhr, Department of Orthopedic Surgery King Saud University, Faculty of Medicine
Saudi Arabia
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DOI: 10.4103/sjsm.sjsm_1_17

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  Abstract 


Background: The causes of noncontact anterior cruciate ligament (ACL) injury pose a great mystery in the orthopedic field.[1] About 100,000 ACL injuries are sustained annually in the United States of America, approximately 70% of the previously mentioned cases are of a noncontact origin.[2],[3],[4] For such a common injury, it will be a great effort to search and address possible modifiable risk factors associated with noncontact ACL injury to establish a preventive measures that will decrease the incidence of it.
Hypothesis: The anthropometric measurements are risk factors for noncontact ACL injury.
Materials and Methods: This study was held in a retrospective fashion, the population will include patients from our institution with a sample size of 2000 cases that will be filtered according to the inclusion and exclusion criteria. Data analysis was performed by expertise.
Data Collection: We used medical records of patient with noncontact ACL injury reconstruction for analysis and review. Data included anthropometric measurements (height, mass, gender, and age at the time of surgery). The targeted population for the study thus includes the following; patients who sustained ACL injuries. We obtained data from records of around 2000 patients with noncontact ACL injuries from 1996 to 2012, which were filtered according to inclusion and exclusions criteria. Inclusion criteria include (1) patients with noncontact ACL injury and (2) subjects with an age range from 25 to 55. Exclusion criteria are (1) traumatic ACL injury, (2) partial ACL injuries, (3) previous ACL reconstructions, (4) multiligamentous injuries, and (5) acute or previous hamstring injuries.
Data Analysis: In our analysis, the sample size was 468 subjects, 212 among contacts (45.3%), and 256 among noncontact (54.7%) although we could have benefit from a large number of female subjects (male 98.9%, female 1.1%) to compare the results with male subjects, the current number that we have is proved to be a good predictive model. The mean age of subjects, 27.16 years for subjects with contact ACL injury, standard deviation (SD) = 6.330 and 28.00 years for subjects with noncontact ACL injury, SD = 6.873, and P = 0.172.
Results: Incidence of ACL injury in obese and nonobese subjects: We define obesity in our study as subject with a body mass index (BMI) >30 is considered as an obese while a subject with a BMI <30 considered as nonobese, the results has showed that subjects who sustained contact ACL injury and obese = 27%, subjects with contact ACL injury and nonobese = 73.2%. While subjects with noncontact ACL injury and obese = 27%; nonobese = 73%. Noncontact ACL versus contact ACL injury in terms of anthropometric measurements: The anthropometric measurements that we study are height, weight, BMI. There was no main significant difference of anthropometric measurement on contact and noncontact ACL injuries groups. We have found that the mean of the weight of contact ACL injury group = 79.64 ± 15.6 and in noncontact ACL injury group was found to be 80.314 ± 16.4 with a P = 0.664. The other variable is height: in contact ACL injury group, the mean was 170.406, and in noncontact ACL injury group, it was 170.509, with P = 0.884. The last variable is BMI with mean 27.377 ± 5.05 among contact ACL injury, while 27.56 ± 5.21 among noncontact ACL injury group.
Conclusion: In this study, we addressed the relationship between anthropometric measurement and noncontact ACL injury in middle-aged patient. Our results show that BMI, weight, height are not significantly considered as risk factor for noncontact ACL injury. There was no comparison in men and women.

  Abstract in Arabic 

ملخص البحث: اسباب اصابات الرباط الصليبي الامامي الغير تصادميه تحمل القليل من الغموض في جراحة العظام.] 1[حوالي 100000 اصابه قطع
2[لمثل هذه الاصابات من الجيد - الرباط الصليبي الامامي تحدث سنويا في الوالايات المتحده الامريكيه , تقريبا 70 % من الاصابات الغير تصادميه.] 4
البحث و معرفه الاسباب الممكن تغييرها والتي ترتبط باصابات الرباط الصليبي الامامي الغير تصادمي ووضع الوسائل التي تقلل من حدوثها.
نظرية البحث: القياسات الانثروبومتريكيه تعتبر احد عوامل المسببه لاصابات الرباط الصليبي الامامي الغير تصادمي.
منهجية البحث: الدراسه عباره عن دراسه استعاديه لملفات المرضى , وحجم العينه 2000 تخضع لعمليه تصفيه بحسب معايير الشمول والاقصاء.
ومن ثم سوف يتم تحليل البيانات .
عملية جمع البيانات: تم استخدام السجلات الطبيه للمرضى الذين تم ترميم الرباط الصليبي الامامي نتيجه اصابه غير تصادميه للمراجعه والتحليل.
البيانات المشموله هي القياسات الانثروبومتركيه ) الطول , الكتله , الجنس. العمر وقت العمليه الجراحيه(.وبالتالي المجتمع المشمول بالدراسه
كالاتي:المرضى الذي لديهم اصابه قطع بالرباط الصليبي.تم جمع بيانات لمرضى لديهم اصابات قطع رباط صليبي غير تصادمي من عام 1996 الى 2012 حيث تم خضوع هذه
البيانات الى معايير الشمول والاقصاء . معايير الشمول هي : ) 1 (مرضى اصابات الرباط الصليبي الامامي الغير تصادمي. ) 2 (ان يتراوح العمر من 25 الى 55 .معايير الاقصاء
هي ) 1(قطع الرباط الامامي نتيجه لحادث , ) 2 (قطع جزئي لرباط, ) 3( من تم ترميم الرباط سابقا لهم, ) 4( اصابه لاربطه عده ,) 5( اصابه حاده او سابقه لعضله الهامسترنق.
256 شخص , ) تحليل البيانات: خلال التحليل , العينه شملت 468 شخص , 212 شخص من اصابه قطع الرباط الامامي التصادمي بنسبة )% 45.3
ممن اصابة قطع الرباط الصليبي الغير تصادمي بنسبة ) 54.7 % (. متوسط الاعمار كان 27.16 سنه للاشخاص الذي لديهم قطع رباط صليبي
P تصادمي وانحراف معياري 6.330 , و 28.00 سنه اعمار من لديهم اصابة قطع رباط صليبي غير تصادمي بانحراف معياري 6.873 , وقيمة
.) كانت ) 0.173

النتائج: حدوث اصابات قطع الرباط الصليبي الامامي في من يعانون من سمنه و من ليس لديهم سمنه , حيث تم تعريف السمنه خلال الدراسه بحساب

مؤشر كتلة الجسم فمن كانت كتلته اكثر من 30 يصنف في مجموع السمنه و من كانت نسبته اقل من 30 يعتبر غير سمين , اوضحت النتائج ان من

لديه اصابة قطع رباط الصليبي الامام التصادمي وسمين 27 % ومن ليس سمين 73.2 . بينما اصابات الرباط الصليبي الامامي الغير تصادمي للذين

يعانون من سمنه % 27 ومن هم غير سمينين 73 %. بمقارنة اصابات الرباط الصليبي التصادمي والغير تصادمي من خلال القياسات الانثروبومتريه

)الطول والوزن ومؤشر كتلة الجسم ( لم يكن هناك اختلاف ملحوظ بينهم. متوسط وزن الاشخاص لمجموعة اصابات الرباط الصليبي الامامي

P 16.4 حيث جاءت قيمة -/+ 15 , لكن الاشخاص في مجموعة الرباط الصليبي الامامي الغير تصادمي 80.314 -/+ التصادمي هي 79.64

0.664 .اما لطول : متوسط الطول لاصابات الرباط الامامي التصادميه كان 170.409 , ولاصابات الرباط الصليبي الامامي الغير تصادميه كان متوسط الطول 170.509
5.05 , ولاصابات الرباط الصليبي الامامي الغير تصادمي -/+ ولمؤشر كتلة الجسم فكان المتوسط لاصابات الرباط الصليبي الامامي التصادمي 27.377 . P و قيمة 0.884
. -5.21/+ 27.56
استنتاج: في هذه الدراسه توضيح العلاقه بين القياسات الانثروبومتريه واصابات الراط الغير تصادميه للمرضى في متوسط العمر.حيث النتائج
اوضحت ان م{شر كتلة الجسم و الطول والوزن ليست من العوامل المسببه لاصابات الرباط الامامي الغير تصادمي.

Keywords: Anterior cruciate ligament injury, anrthropmetric measurment, middle age


How to cite this article:
ALJassir F, Nasser AB, Bin Khidhr RM. The anthropometric measurements as predisposing factor for noncontact anterior cruciate ligament injury in middle-aged women. Saudi J Sports Med 2018;18:67-70

How to cite this URL:
ALJassir F, Nasser AB, Bin Khidhr RM. The anthropometric measurements as predisposing factor for noncontact anterior cruciate ligament injury in middle-aged women. Saudi J Sports Med [serial online] 2018 [cited 2018 Nov 17];18:67-70. Available from: http://www.sjosm.org/text.asp?2018/18/2/67/243346




  Introduction Top


The causes of noncontact anterior cruciate ligament (ACL) injury pose a great mystery in the orthopedic field.[1] About 100,000 ACL injuries are sustained annually in the United States of America, approximately 70% of the previously mentioned cases are of a noncontact origin.[2],[3],[4] For such a common injury, it will be a great effort to search and address possible modifiable risk factors associated with noncontact ACL injury to establish a preventive measures that will decrease the incidence of it. In literature, the risk factors for noncontact ACL injuries have been thoroughly investigated and categorized in four following general divisions: environmental, anatomic, hormonal, and biomechanical.[2] Anatomical variances include joint hyperextension, subtalar pronation, hamstring muscle strength, hamstring tightness, and quadriceps angle.[5] As for biomechanical differences, the literature concluded that small knee flexion angle and large posterior ground reaction force in addition to large knee valgus moment are risk factors of noncontact ACL injury.[6] Anatomical variances include joint hyperextension, subtalar pronation, hamstring muscle strength, hamstring tightness, and quadriceps angle.[5] As for biomechanical differences, the literature concluded that small knee flexion angle and large posterior ground reaction force in addition to large knee valgus moment are risk factors of noncontact ACL injury.[6] It has been documented in the literature that patients with ACL injury underwent either conservative measure or surgical reconstruction of ACL have shown radiological abnormality consistent with osteoarthritic changes, which affect functionality of the patient.[7] In our research, we are debating the subject of middle-aged women suffering from noncontact ACL injury since it has been proven that they are more susceptible to acquire this form of injury due to having stronger quadriceps muscles as opposed to hamstring muscles.[8] The importance of this research relies on the impact it will leave on the society by affecting the treatment and prevention guidelines. As we mentioned earlier, the preventive aspect of ACL injury have not been tackled deeply. Thus, we will incorporate the factors that have been proven to be of association in the literature with those of suspicion.


  Materials and Methods Top


Study design

This study was held in a retrospective fashion, the population will include patients of our institution with a sample size of 2000 cases that will be filtered according to the inclusion and exclusion criteria. Data analysis was performed by expertise.

Data collection

We used medical records of patient with noncontact ACL injury reconstruction for analysis and review. Data included anthropometric measurements (height, mass, gender, and age at the time of surgery). The targeted population for the study thus includes the following; patients who sustained ACL injuries. We obtained data from records of around 2000 patients with noncontact ACL injuries from 1996 to 2012, which were filtered according to inclusion and exclusions criteria. Inclusion criteria include (1) patients with noncontact ACL injury and (2) subjects with an age range from 25 to 55. Exclusion criteria are (1) traumatic ACL injury, (2) partial ACL injuries, (3) previous ACL reconstructions, (4) multiligamentous injuries, (5) acute or previous hamstring injuries. We obtained medical records of the patients and we started opening the files manually and collecting data which include age, weight, and height and we calculate the formula:

Body mass index (BMI) = weight (kg)/height (m)2

During collecting and filtering data, we collect 468 patients out of 2000. The reasons were there were missing files in medical records departments, bad hand writing, patients who does not fit our inclusion criteria and in completed data.

Data analysis

Descriptive statistics were calculated for each risk factor with SPSS (IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp). A significance level of P < 0.05 was set for all hypothesis tests. A two-factor analysis of variance with each risk factor as a dependent variable was used to determine whether the result of subjects who had noncontact ACL injury had a BMI >30 or <30. In our analysis, the sample size was 468 subjects, 212 among contacts (45.3%) and 256 among noncontact (54.7%) although we could have benefit from a large number of female subjects (male 98.9%, female 1.1%) to compare the results with male subjects, the current number that we have is proved to be a good predictive model. The mean age of subjects, 27.16 of subjects with contact ACL injury, standard deviation (SD) = 6.330; 28.00 of subjects with noncontact ACL injury SD = 6.873 and P = 0.172.

Incidence of anterior cruciate ligament injury in obese and nonobese subjects

We define obesity in our study as subject with a BMI >30 is considered as an obese while a subject with a BMI <30 considered as nonobese, the results have showed that subjects who sustained contact ACL injury and obese = 27%, subjects with contact ACL injury and nonobese = 73.2%. While subjects with noncontact ACL injury and obese = 27%; nonobese = 73%.

Noncontact anterior cruciate ligament versus contact anterior cruciate ligament injury in term of anthropometric measurements

The anthropometric measurements that we study it are: height, weight, BMI. There was no main significant difference of anthropometric measurement on contact and noncontact ACL injuries groups. We have found that the mean of the weight of contact ACL injury group = 79.64 ± 15.6, and in noncontact ACL injury group was found to be 80.314 ± 16.4 with a P = 0.664. The other variable is height, in contact ACL injury group the mean was 170.406 and noncontact ACL injury was 170.509 with P = 0.884. The last variable is BMI with mean 27.377 ± 5.05 among contact ACL injury, while 27.56 ± 5.21 among noncontact ACL injury group.


  Discussion Top


Being a common injury, decreasing its occurrence by defining its risk factors would be of a great benefit to the patients and surgeons. Studies have been focusing on some general aspects in the population. The intention of this study is to establish the risk factors for noncontact ACL injuries in middle-aged patients; whether anthropometric measurements such as height, weight, and BMI can identify the risk of having a noncontact ACL injury. We carefully reviewing and evaluating data to identify an anthropometric measurement may predispose to a noncontact ACL injury. In our study, we did not include the comparison of the result between men and women because a large percentage of the sample was men 99.9% and because the aim of the study was completely focused on the modifiable risk factors (BMI and weight) and the comparison between contact and noncontact ACL injuries.

In [Figure 1], we tried to present the effect of obesity and associated high body load on the knees may predispose to occurrence of ACL injury. We calculated BMI for each patient and we defined the obesity as BMI >30 and nonobesity as BMI <30. The result was surprising, which showed a large percentage of either contact and noncontact ACL injuries were among nonobese group; however, we do not know whether the BMI was changed between the time of injury and the time of surgery; Furthermore, BMI cannot directly measure the muscle fitness, which higher than normal BMI can be associated with a greater muscle mass than typical people, which can considered as protective against ACL injury. [Table 1] shows the comparison between contact and noncontact ACL injuries. Unfortunately, all the risk factors (BMI, height, and weight) were no significant difference between contact and noncontact ACL injuries [Table 1].
Figure 1: Type of anterior cruciate ligament injury

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Table 1: Ilustrate a comparison between contact and non-contact ACL injury

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  Conclusion Top


In this study, we addressed the relationship between anthropometric measurement and noncontact ACL injury in middle-aged patient. Our results show that BMI, weight, and height are not significantly considered as risk factor for noncontact ACL injury. There was no comparison in men and women.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kirkendall DT, Garrett WE Jr. The anterior cruciate ligament enigma. Injury mechanisms and prevention. Clin Orthop Relat Res 2000;372:64-8.  Back to cited text no. 1
    
2.
Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, Garrett WE, et al. Noncontact anterior cruciate ligament injuries: Risk factors and prevention strategies. J Am Acad Orthop Surg 2000;8:141-50.  Back to cited text no. 2
    
3.
Huston LJ, Greenfield ML, Wojtys EM. Anterior cruciate ligament injuries in the female athlete. Potential risk factors. Clin Orthop Relat Res 2000;372:50-63.  Back to cited text no. 3
    
4.
Boden BP, Griffin LY, Garrett WE Jr. Etiology and prevention of noncontact ACL Injury. Phys Sportsmed 2000;28:53-60.  Back to cited text no. 4
    
5.
Evans KN, Kilcoyne KG, Dickens JF, Rue JP, Giuliani J, Gwinn D, et al. Predisposing risk factors for non-contact ACL injuries in military subjects. Knee Surg Sports Traumatol Arthrosc 2012;20:1554-9.  Back to cited text no. 5
    
6.
Myer GD, Ford KR, Khoury J, Succop P, Hewett TE. Biomechanics laboratory-based prediction algorithm to identify female athletes with high knee loads that increase risk of ACL injury. Br J Sports Med 2011;45:245-52.  Back to cited text no. 6
    
7.
Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med 1994;22:632-44.  Back to cited text no. 7
    
8.
Ebben WP, Fauth ML, Petushek EJ, Garceau LR, Hsu BE, Lutsch BN, et al. Gender-based analysis of hamstring and quadriceps muscle activation during jump landings and cutting. J Strength Cond Res 2010;24:408-15.  Back to cited text no. 8
    


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