Increased Lateral Femoral Condyle Ratio Is Associated With a Greater Risk of Anterior Cruciate Ligament Injury and Concomitant Anterolateral Ligament and Meniscus Injuries.

Purpose: To investigate whether lateral femoral condyle ratio (LFCR) and lateral femoral condyle index (LFCI) were associated with a greater risk of anterior cruciate ligament (ACL) injury and concomitant injuries.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO. PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to April 1, 2024. Studies evaluating the association between LFCR or LFCI and ACL injury were included. The following data were extracted: first author's name, study design, level of evidence, information of participants, radiologic method of measurement, and mean values for LFCR and LFCI. The quality assessment followed the Methodological Index for Non-Randomized Studies tool. The literature search, data extraction, and quality assessment were conducted by 2 authors independently.

Results: A total of 14 studies comprising 2,386 participants were included. Notably, 11 studies explored the association between LFCR and ACL. Six studies showed that the mean LFCR in ACL injury group (range, 62.65%-70.1%) was significantly greater than control group (range, 59.3%-66.8%). Five studies reported that the increased LFCR was associated with a greater risk of concomitant anterolateral ligament injury and meniscal tear. However, 2 studies reported no significant association between LFCR and ACL reconstruction revision, with a mean LFCR ranging from 62.5% to 64.4% in the ACL reconstruction revision group and 62.8% to 64.2% in the primary ACL group. In addition, 2 studies reported that decreased LFCI was associated with a greater risk of ACL injury ranging from 0.60 to 0.78 for the ACL injury group and 0.60 to 0.85 for controls.

Conclusions: Increased LFCR was associated with a greater risk of ACL injury and concomitant anterolateral ligament injuries and meniscal tears. Furthermore, decreased LFCI was associated with a higher risk of ACL injury.

Level Of Evidence: Level III, systematic review of Level III studies.