Reduced bone mineral density and computed tomography values of the proximal tibia are associated with avulsion fractures of the anterior and posterior cruciate ligaments in adults: A case-control study - 19/06/26
Abstract |
Background |
While recent studies of cruciate ligament injuries have predominantly focused on tibial and femoral morphological characteristics, the relationship between bone mass and the risk of tibial attachment avulsion fracture (TAF) remains unclear. To determine whether compromised bone quality contributes to TAF occurrence, we examined: (1) whether bone mineral density (BMD) differs between TAF patients and controls; (2) whether proximal tibial bone mass measured by three-dimensional computed tomography (3D-CT) differs between groups; and (3) which CT plane best predicts TAF risk.
Hypothesis |
Lower BMD and reduced bone mass of the proximal tibia are associated with an increased incidence of TAFs.
Patients and methods |
From January 2012 to October 2024, 87 patients with TAFs were identified and matched with 87 controls based on age (±5 years), sex, and site of the injured ligament. Among these 87 patients, 39 underwent both BMD testing and 3D-CT. These 39 patients were further matched (1:3) with controls based on age, sex, and site of the injured ligament. Pearson’s correlation analysis was used to assess the linear relationship between BMD T-scores and 3D-CT values of the proximal tibia, while multivariate logistic regression analysis was applied to evaluate the association of BMD and CT values with the occurrence of TAFs.
Results |
The BMD T-scores and 3D-CT values of the proximal tibia were significantly lower in the TAF group than the control group ( p < 0.001). Lower BMD was identified as a risk factor for TAF (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.339–0.798, p < 0.001). The axial 3D-CT value was most strongly associated with the incidence of TAF (OR = 0.976, 95% CI = 0.964–0.988, p < 0.001), followed by coronal (OR = 0.984, 95% CI = 0.975–0.994, p < 0.01), sagittal (OR = 0.987, 95% CI = 0.977–0.997, p < 0.05), and cumulative (OR = 0.992, 95% CI = 0.988–0.996, p < 0.001). Lower BMD T-scores and 3D-CT values of the proximal tibia were associated with an increased risk of TAF.
Discussion |
Lower BMD T-scores and 3D-CT values of the proximal tibia were significantly associated with an increased risk of TAF, extending beyond morphological factors emphasized in the recent literature. These findings may assist clinicians in identifying high-risk patients and underscore the importance of monitoring bone mass for TAF management.
Level of evidence |
III, case control study.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Proximal tibia peak bone mass, Anterior/posterior cruciate ligament (ACL/PCL), tibial avulsion, Tibial avulsion injuries, Body mass index, Osteoporosis
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