Tibial Spine Height Measured by Radiograph is A Risk Factor for Non-Contact Anterior Cruciate Ligament Injury in Males: A Retrospective Case-Control Study

Abstract Objectives: To determine the relationship between non-contact anterior cruciate ligament (ACL) injury and tibial spine width or height and to verify whither the relationships vary from males to females. Design: Retrospective case-control study, level of evidence III. Methods: Ninety-six patients with non-contact primary ACL injuries and 96 patients with intact ACL were recruited in our institution from 2017 to 2019. The patients were divided into male and female subgroups. The tibial plateauwidth (TPW), medial and lateral tibial spine height(MTSH and LTSH, respectively), and tibial spine width (TSW) were measured by radiographs. The ratios of TSW/TPW, LTSH/TPW, and MTSH/TPW were used to normalize these length parameters. We compared these parameters between subgroups. Binary regression mode, receiver operating characteristic curves and the area under the curve (AUC) were used to evaluate the contributions of the parameters to ACL injury. Results: The median value of TSW/TPW was smaller in the study group than in the control group (15.2% vs. 17.3%, P<0.001). The ratio of LTSH/TPW was larger in ACL-injured patients (median, 12.0%) than in ACL-intact controls (median, 11.6%) (P=0.015). The LTSH/TPW (P=0.007) and MTSH/TPW(P=0.002) were larger in males (12.3% and 12.9%, respectively) than in females (11.6% and 11.9%, respectively) in the study group. In males, the LTSH/TPW had an AUC of 0.709 for ACL injury. The LTSH/TPW and MTSH/TPW revealed significant ORs of 1.73 (95% CI [1.29-2.33], P<0.001) and 1.53 (95% CI [1.16-2.03], P=0.003) for ACL injury in males, respectively. Conclusions: When taking individual differences into account, the tibial spine height varies from male to female in patients with ACL injury and is a risk factor for ACL injury in males. The influence of the increased lateral tibial spine height in patients with ACL, male patients in particular, on the impingement between the grafts and lateral tibial spine warrants further investigation.