Risk factors associated with noncontact injury of the anterior cruciate ligament - A prospective four-year evaluation of 859 West Point cadets

Background: The causes of noncontact anterior cruciate ligament injury remain an enigma. Purpose: To prospectively evaluate risk factors for noncontact anterior cruciate ligament injuries in a large population of young athletic people. Study Design: Prospective cohort study. Methods: In 1995, 1198 new United States Military Academy cadets underwent detailed testing and many parameters were documented. During their 4-year tenure, all anterior cruciate ligament injuries that occurred were identified. Statistical analyses were used to identify the factors that may have predisposed the cadets to noncontact anterior cruciate ligament injuries. Results: Among the 895 cadets who completed the entire 4-year study, there were 24 noncontact anterior cruciate ligament tears (16 in men, 8 in women). Significant risk factors included small femoral notch width, generalized joint laxity, and, in women, higher than normal body mass index and KT-2000 arthrometer values that were 1 standard deviation or more above the mean. The presence of more than one of these risk factors greatly increased the relative risk of injury. All female cadets who had some combination of risk factors sustained noncontact anterior cruciate ligament injuries, indicating that some combinations of factors are especially perilous to the female knee. Conclusion: Several risk factors may predispose young athletes to noncontact anterior cruciate ligament injury. (C) 2003 American Orthopaedic Society for Sports Medicine.