Editorial Commentary: Unlike Modifiable Factors, Non-Modifiable Risk Factors for Anterior Cruciate Ligament Injury Including Lateral Femoral Condyle Ratio and Lateral Femoral Condyle Index Have Low Clinical Relevance.

Abstract

Risk factor mitigation is of the utmost concern in the prevention of primary anterior cruciate ligament (ACL) injuries. Known anatomic risks for ACL injury include varus deformity of the knee, increased posterior tibial slope, decreased femoral notch width, and more recently, increased lateral femoral condyle ratio (LFCR) and decreased lateral femoral condyle index. Whereas some authors recommend knee osteotomy in the revision setting to correct deformities of the proximal tibia, osteotomy to decrease posterior femoral condyle depth has not been described, to my knowledge, although lateral extra-articular tenodesis in cases of an increased LFCR during revision ACL reconstruction has been recommended. Increased posterior femoral condyle depth as measured by the LFCR is non-modifiable and therefore lacks clinical use in the prevention of primary ACL injuries. Providers should focus on modifiable factors such as quadriceps strength, core strengthening, and altered landing mechanics in the prevention of primary ACL injury.