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ACL injuries: A bigger ligament may be a better ligament

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When it comes to ACL injuries, size may matter.

The anterior cruciate ligament is the bane of many exercisers and athletes. Found behind the kneecap, it’s responsible for keeping the knee stable and is the most often injured knee ligament. Athletes are especially vulnerable because the ACL can tear or fray during moves such as jumping, pivoting or stopping quickly. Women are especially at risk.

A recent study found that injured ACLs are also often smaller ACLs. Researchers from Ohio State University performed magnetic resonance imaging scans on the non-injured knee of 27 people who had suffered a previous non-contact ACL injury. They compared them to a 27-person matched control group to see if there was a difference in the size of the ligament between the two groups.

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Among the previously injured study participants, 16 had smaller ACLs than the control group. The average ACL volume of the injured participants was 1,921 cubic millimeters, while the non-injured group had an average ACL volume of 2,151 cubic millimeters.

A larger ACL could equal a stronger ACL, according to Ajit Chaudhari, assistant professor of orthopedics at Ohio State and lead author of the study, the results of which appeared recently in the American Journal of Sports Medicine. ‘If you have a weaker ACL, it’s more likely to tear if all other factors are equal,’ he said in a news release. ‘If being larger in size means the ACL has more fibers, then that would make it stronger. If the individual building blocks are of similar strength, then it comes down to how much total tissue there is.’

The researchers caution that this doesn’t mean that having a smaller ACL will always trigger an injury. And they don’t recommend having knees screened via MRIs to see if they may be at risk. But they do think there may be potential in finding out how the ACL can be strengthened, made larger, or both, while a child is still developing.

-- Jeannine Stein

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