Editorial Commentary: Osseous Anatomy of the Knee in Female Patients is a Significant Risk Factor for Anterior Cruciate Ligament Injury and Anterior Cruciate Ligament Graft Failure

Risk for anterior cruciate ligament (ACL) injury is greater in female than in male patients for a myriad of reasons, with osseous anatomy about the knee proving to be one significant risk factor for ACL injury and/or ACL graft failure. While femoral intercondylar notch size/shape and posterior tibial slope have been well-examined in this regard for their contribution to potential ACL injury, morphology of the lateral femoral condyle is a newer entity that may be linked to risk for ACL injury. Smaller/stenotic femoral intercondylar notches, increased posterior tibial slope of the lateral tibial plateau, and increased posterior condylar depth of the lateral femoral condyle have all been shown to increase risk for ACL injury and/or ACL graft failure. Such associations provide knee surgeons with food for thought when considering procedures such as notchplasty, staged anterior closing wedge high tibial osteotomy, and anterolateral ligament reconstruction/augmentation at the time of primary or revision ACL reconstruction. Further investigation into the links between pre-operative imaging parameters and outcomes following such concomitant procedures is required in order for any significant conclusions to be drawn.