Demographic characteristics of the study populations.

Abstract: Background: Anterior cruciate ligament (ACL) injuries are prevalent and can have debilitating consequences, with various factors potentially influencing their occurrence. This multicentric study aimed to comprehensively analyze the epidemiological characteristics of ACL injuries. We hypothesized that specific patient characteristics, such as age, sex, body mass index (BMI), and sports involvement, would be associated with distinct injury patterns and risk profiles. Methods: This cross-sectional study analyzed the medical records of 712 patients aged 15–60 diagnosed with ACL rupture. Data on demographics, injury mechanisms, associated injuries, graft type, and sports involvement were collected. Results: The majority of patients were male (93.1%), aged 15–30 years (80.2%), and overweight (66.7%). Autografts were the predominant graft choice (96.07%). Associated injuries were present in 79.5% of cases, with medial meniscus ruptures being the most common (37.36%). Sports-related (49.3%) and non-sports-related (50.7%) injuries were nearly equal, with non-contact injuries more prevalent (71.1%). In the sports-related subgroup, associated injuries emerged as a significant risk factor for ACL rupture (p = 0.014, OR = 1.596, 95% CI: 1.101–2.314), whereas non-contact mechanisms showed borderline significance (OR = 0.75, p = 0.09). Moreover, younger athletes were more susceptible to sports-related injuries (p = 0.024), with football being the primary sport involved. Conclusions: This study identified a high prevalence of concomitant injuries with ACL injury, which increased the risk of ACL injury, particularly in sports-related cases. Age-related differences in injury patterns highlight the need for age-appropriate preventive measures, especially for younger athletes participating in high-risk sports. This underscores the need for comprehensive injury assessment, targeted prevention strategies, and optimized clinical management approaches tailored to different populations’ specific characteristics and risks.Keywords: anterior cruciate ligament; ACL injury; sports injury; risk factors; injury mechanism; injury prevention

Creating awareness about a disorder is important for prevention from the perspective of public health. However, for sports injuries, like the anterior cruciate ligament (ACL) injury, there is no study which has investigated the awareness of risk factors for the injury and prevention methods among the general population, to the best of our knowledge. The sources of information among the population are also unclear. The purpose of present study was to identify these aspects of public awareness about the ACL injury.

A questionnaire was randomly distributed among the general population registered with a web based questionnaire supplier, to recruit 900 participants who were aware about the ACL injury. The questionnaire consisted of two parts: Question 1 asked them about their sources of information regarding the ACL injury; Question 2 asked them about the risk factors for ACL injury. Multivariate logistic regression was used to determine the information sources that provide a good understanding of the risk factors.

The leading source of information for ACL injury was television (57.0%). However, the results of logistic regression analysis revealed that television was not an effective medium to create awareness about the risk factors, among the general population. Instead “Lecture by a coach”, “Classroom session on Health”, and “Newspaper” were significantly effective in creating a good awareness of the risk factors (p < 0.001).

Preparation of this data collection was funded by grant

90-A-1279 from the United States Department of Health and Human

Services, Administration on Aging. Estimates of the population of persons 60 years old and older were received from the Census Bureau in printed form and were made machine-readable by staff at ICPSR. Other variables contained in this dataset were merged from existing machine-readable census files. The data concerning racial composition of counties were taken from the CENSUS OF POPULATION AND HOUSING, 1980 [UNITED STATES]: P.L. 94-171 POPULATION COUNTS (ICPSR 7854). The figures concerning per capita income were taken from the Bureau of the Census, GENERAL REVENUE SHARING, 1978 POPULATION ESTIMATES (ICPSR 7840). Variables include Federal Information Processing Standard (FIPS) state and county codes, 1978 per capita income of county, and total population of county broken down by sex, race, and age (in four-year increments with a category for persons 75 years old and older).

The global Anterior Cruciate Ligament (ACL) Reconstruction Procedures market is experiencing robust growth, driven by increasing incidence of sports injuries, a rising geriatric population susceptible to ACL tears, and advancements in surgical techniques and implant technologies. The market size in 2025 is estimated at $2.5 billion, exhibiting a Compound Annual Growth Rate (CAGR) of 6% during the forecast period (2025-2033). This growth is fueled by the increasing adoption of minimally invasive surgical procedures, resulting in faster recovery times and reduced hospital stays. The segment for allografts is witnessing faster growth than autografts due to the reduced morbidity associated with harvesting donor tissue. Hospital-based procedures currently dominate the application segment, although ambulatory surgery centers are experiencing significant growth due to their cost-effectiveness and convenience. North America currently holds the largest market share, owing to high healthcare expenditure and advanced medical infrastructure; however, Asia-Pacific is projected to exhibit the fastest growth rate due to rising disposable incomes and increased awareness of ACL reconstruction procedures. Key players like Stryker Corporation, DePuy Synthes, and Smith & Nephew are driving innovation through research and development, expanding their product portfolios, and strategic partnerships to maintain their market leadership. Technological advancements continue to shape the ACL reconstruction market. The development of biocompatible and durable implants, coupled with the integration of robotic-assisted surgery, is enhancing precision and improving patient outcomes. The increasing adoption of minimally invasive techniques like arthroscopy further contributes to the market expansion. However, the high cost of treatment and the risk of complications associated with surgery remain significant restraints. Furthermore, the reimbursement policies and regulations vary across different regions, posing challenges to market growth. Despite these challenges, the market outlook for ACL reconstruction procedures remains positive, driven by ongoing technological advancements, rising prevalence of ACL injuries, and an expanding elderly population. The competitive landscape is characterized by intense rivalry among established players and emerging companies, driving innovation and improving accessibility of this crucial surgical intervention.

ACL Graft Market size was valued at USD 0.12 Billion in 2024 and is projected to reach USD 0.21 Billion by 2032, growing at a CAGR of 7.4% from 2025 to 2032.

ACL Graft Market Drivers

Rising prevalence of sports injuries: Increased participation in sports like soccer, basketball, and skiing leads to a higher incidence of ACL tears.

Aging population: The aging population is more susceptible to age-related musculoskeletal issues, including ACL injuries.

Technological advancements: Improved surgical techniques, graft materials, and rehabilitation methods enhance treatment outcomes.

Growing awareness: Increased awareness among athletes and the general public about ACL injuries and available treatment options.

Focus on active lifestyles: A growing emphasis on physical activity and sports participation across all age groups.

ACL Reconstruction Market Outlook

The ACL Reconstruction market size was valued at approximately USD 5.2 billion in 2023 and is projected to reach USD 9.3 billion by 2032, growing at a CAGR of 6.7% over the forecast period. This robust growth is driven by an increasing prevalence of sports-related injuries, advancements in surgical techniques, and a rising awareness regarding the benefits of early intervention in ligament injuries.

One of the primary growth factors in the ACL Reconstruction market is the rising incidence of sports and exercise-related injuries. With a global increase in participation in physical activities and sports, both at amateur and professional levels, the demand for effective and reliable surgical interventions for ACL injuries has surged. Additionally, the aging population, which is more susceptible to knee injuries, further propels the market. The awareness campaigns by healthcare organizations about the importance of timely and effective treatment for ACL injuries have also contributed to the market's expansion.

Technological advancements in surgical procedures and materials are also playing a significant role in the growth of the ACL Reconstruction market. Innovations such as minimally invasive surgeries, improved graft materials, and advanced fixation devices have made ACL reconstruction procedures more efficient, with quicker recovery times and lower risks of complications. These advancements not only enhance the outcomes for patients but also attract more individuals to opt for surgical interventions, thereby driving market growth.

Furthermore, the rising healthcare expenditure and well-established healthcare infrastructure in developed regions are contributing significantly to the market's growth. Governments and private organizations are investing more in healthcare facilities, advanced medical devices, and research & development, which in turn, enhances the overall quality of care. This is particularly evident in countries like the United States, Canada, Germany, and the United Kingdom, where the accessibility and affordability of advanced surgical procedures are higher, leading to increased market penetration.

The integration of Artificial Tendons and Ligaments into ACL reconstruction procedures represents a significant advancement in orthopedic surgery. These synthetic alternatives are designed to mimic the mechanical properties of natural ligaments, offering a promising solution for patients who may not be ideal candidates for traditional grafts. The development of these artificial options is driven by the need for consistent quality and availability, as they eliminate the variability associated with biological grafts. With ongoing research and improvements in biomaterials, artificial tendons and ligaments are becoming increasingly viable, providing surgeons with more options to tailor treatments to individual patient needs. This innovation not only enhances surgical outcomes but also reduces the dependency on donor tissues, addressing potential shortages and ethical concerns.

From a regional perspective, North America currently dominates the ACL Reconstruction market due to the high prevalence of sports injuries, advanced healthcare infrastructure, and the presence of major market players. However, the Asia Pacific region is expected to witness the highest growth rate during the forecast period, driven by the growing participation in sports, increasing healthcare expenditure, and improving medical infrastructure. Countries like China, India, and Japan are seeing a rise in awareness about sports injuries and the availability of advanced treatment options, which is expected to boost the market in this region.

Graft Type Analysis

The ACL Reconstruction market can be segmented by graft type into autograft, allograft, and synthetic graft. Autografts are currently the most commonly used grafts in ACL reconstruction surgeries. This preference is largely due to the high success rates and lower chances of rejection associated with autografts, as they are harvested from the patient's own body, typically from the patellar tendon, hamstring, or quadriceps tendon. The autograft segment is expected to continue its dominance due to these advantages, along with advancements in surgical techniques that enhance the efficacy of autograft procedures.

Allografts, which are harvested from a deceased donor, are gaining traction, particularly in cases where mul

The Anterior Cruciate Ligament (ACL) Reconstruction market is experiencing robust growth, driven by increasing sports injuries, rising geriatric population prone to falls and subsequent ACL tears, and advancements in surgical techniques and implant materials. The market, encompassing tissue and bone fixation solutions across hospitals, orthopedic clinics, and ambulatory surgical centers, is projected to witness a significant expansion over the forecast period (2025-2033). Major players like Zimmer Biomet, Smith & Nephew, and Arthrex are at the forefront of innovation, continuously developing minimally invasive procedures and biocompatible implants to improve patient outcomes and reduce recovery times. This competitive landscape fuels ongoing research and development, leading to improved surgical instruments and enhanced fixation techniques. The geographic distribution of the market reflects high demand in developed regions like North America and Europe due to factors such as higher healthcare expenditure, advanced medical infrastructure, and increased awareness regarding ACL injuries. However, emerging markets in Asia-Pacific and the Middle East & Africa are showing promising growth potential, driven by increasing disposable income, improving healthcare infrastructure, and growing sports participation. While the market faces some restraints like high surgical costs and the risk of complications associated with ACL reconstruction, these are being mitigated through the development of cost-effective solutions and enhanced surgical training programs. The increasing adoption of minimally invasive techniques, such as arthroscopic surgery, is accelerating market growth. The segment focusing on tissue fixation methods is anticipated to maintain a significant share due to the inherent complexity of ACL reconstruction which requires robust and reliable tissue repair. Further segmentation by application reveals a strong presence in hospitals, reflecting the specialized infrastructure and experienced surgical staff needed for these procedures. The overall market trajectory indicates a strong future outlook for the ACL Reconstruction market, with continued expansion expected across diverse geographical segments. The market is expected to show significant growth in emerging economies based on their rising population and increased participation in sports.

Demographic characteristics of patients with (sub)acute and chronic ACL tears.

The global Anterior Cruciate Ligament (ACL) Reconstruction market, valued at $2,746 million in 2025, is projected to experience robust growth, driven by a compound annual growth rate (CAGR) of 8.8% from 2025 to 2033. This expansion is fueled by several key factors. Rising incidence of ACL injuries, particularly among young, active individuals participating in sports like soccer and basketball, is a major driver. Technological advancements in surgical techniques, including minimally invasive arthroscopic procedures and improved implant designs (e.g., biocompatible materials and enhanced fixation methods), are contributing to better patient outcomes and increased adoption of ACL reconstruction surgeries. The aging global population also plays a role, as osteoarthritis and other age-related conditions often necessitate ACL reconstruction. Furthermore, increasing healthcare expenditure and improved access to specialized orthopedic care in developing nations are expanding the market's reach. The market is segmented by application (hospitals, orthopedic clinics, ambulatory surgical centers) and type of fixation (tissue and bone). Hospitals currently dominate the application segment, while bone fixation holds a larger market share within the fixation type segment due to its wider applicability and established efficacy. Leading companies like Zimmer Biomet, Smith & Nephew, and Arthrex are driving innovation and competition within the market. Geographic distribution shows significant regional variations. North America currently holds the largest market share due to high healthcare spending, a large patient pool, and advanced medical infrastructure. However, Asia-Pacific is anticipated to witness the fastest growth rate during the forecast period, propelled by a rising middle class, increasing awareness of ACL injuries and treatment options, and growing healthcare infrastructure investments in countries like India and China. While the market faces restraints such as the high cost of procedures and potential complications associated with surgery, the overall outlook remains optimistic due to the strong underlying growth drivers. The market's future is shaped by the continuous development of innovative implants, improved surgical techniques, and expanding access to quality healthcare. The increasing demand for minimally invasive procedures and personalized medicine approaches will further drive market growth in the coming years.

Cruciate Ligament Repair Market size was valued at $ 3.9 Bn in 2024 and is expected to reach $ 6.2 Bn by 2032, growing at a CAGR of 5.9% from 2026 to 2032Global Cruciate Ligament Repair Market DriversThe market drivers for the cruciate ligament repair market can be influenced by various factors. These may include:Rising Incidence of Sports Injuries: A growing number of individuals participating in sports and physical activities globally has led to a higher incidence of ligament injuries, especially ACL tears. This directly contributes to the demand for cruciate ligament repair procedures.Aging Population and Increased Mobility Needs: As the global population ages, more elderly individuals seek to maintain active lifestyles. This demographic trend leads to more orthopedic interventions, including cruciate ligament repairs, driving market growth.

The Anterior Cruciate Ligament (ACL) Repair market is experiencing robust growth, driven by increasing incidence of ACL injuries, particularly among athletes and young adults. The market, valued at approximately $2.5 billion in 2025, is projected to exhibit a Compound Annual Growth Rate (CAGR) of 7% from 2025 to 2033. This growth is fueled by several factors, including advancements in surgical techniques (minimally invasive procedures), improved rehabilitation protocols leading to faster recovery times, and a rising awareness of ACL injury prevention strategies. The increasing prevalence of sports-related injuries globally, coupled with a growing aging population susceptible to ACL tears from falls and other trauma, significantly contributes to market expansion. The segment encompassing autograft procedures currently dominates the market, reflecting a preference for using the patient's own tissue. However, allograft procedures are experiencing notable growth, driven by advancements in tissue processing and preservation techniques, along with potential advantages in certain patient populations. Hospitals represent the largest application segment, while the ambulatory surgical center segment is exhibiting the fastest growth rate, reflecting a trend toward cost-effective and less invasive procedures. Key players such as Stryker, Smith & Nephew, and Arthrex are actively investing in R&D, focusing on innovative implant designs and surgical tools, further boosting market competition and growth. The geographic distribution of the ACL repair market mirrors global trends in healthcare spending and sports participation. North America currently holds the largest market share due to high healthcare expenditure, advanced medical infrastructure, and a high prevalence of sports-related injuries. However, regions like Asia-Pacific are exhibiting significant growth potential, driven by rising disposable incomes, increasing awareness of healthcare, and the expanding sports industry. Factors such as high surgical costs, particularly in developing nations, and the potential risks associated with ACL surgery act as restraints on market expansion. Nonetheless, the overall market outlook remains positive, with continued innovation and growth anticipated throughout the forecast period. The increasing availability of minimally invasive techniques and improved rehabilitation protocols is expected to reduce recovery time and improve patient outcomes, further accelerating market growth.

Ligament Augmentation Market Outlook

The global ligament augmentation market size was valued at approximately USD 1.5 billion in 2023 and is projected to reach USD 3.2 billion by 2032, growing at a compound annual growth rate (CAGR) of 8.5% during the forecast period. This growth is largely driven by increasing incidences of sports-related injuries and advancements in medical technology. The rising geriatric population and their susceptibility to ligament injuries also play a significant role in the market's expansion.

One of the primary growth factors for the ligament augmentation market is the increasing prevalence of sports injuries. As more individuals participate in recreational and professional sports, the incidence of ligament injuries, particularly in the knees, shoulders, and ankles, has risen. Innovations in surgical techniques, such as minimally invasive procedures, are also driving the market. These advancements offer faster recovery times, reduced pain, and lower risk of complications, making ligament augmentation a more attractive option for patients.

Another critical factor contributing to the market's growth is the aging population. With age, the risk of ligament injuries increases due to the natural wear and tear of the musculoskeletal system. This demographic shift is expected to drive demand for ligament augmentation procedures, as older adults seek to maintain their mobility and quality of life. Additionally, the growing awareness about the benefits of early diagnosis and treatment of ligament injuries is encouraging more people to opt for surgical interventions, further boosting the market.

The rising healthcare expenditure and the increasing number of healthcare facilities worldwide are also significant drivers for the ligament augmentation market. Governments and private organizations are investing heavily in healthcare infrastructure, leading to improved access to advanced medical treatments, including ligament augmentation procedures. Moreover, favorable reimbursement policies in several countries are making these procedures more accessible to a broader population, contributing to the market's growth.

Regionally, North America holds the largest share of the ligament augmentation market, driven by the high prevalence of sports injuries, advanced healthcare infrastructure, and significant healthcare spending. Europe follows closely, with a growing emphasis on sports and physical activities and an increasing aging population. The Asia Pacific region is expected to witness the highest growth rate during the forecast period, fueled by the rising disposable income, improving healthcare facilities, and increasing awareness about ligament augmentation procedures.

The introduction of Acl Repair Implant technology has marked a significant advancement in the field of ligament augmentation. These implants are specifically designed to address anterior cruciate ligament (ACL) injuries, which are among the most common and debilitating sports injuries. The Acl Repair Implant provides a robust solution by offering enhanced stability and support to the injured ligament, facilitating a quicker and more effective recovery process. This technology not only aids in restoring the knee's natural biomechanics but also reduces the risk of re-injury, making it a preferred choice among athletes and active individuals. As the demand for efficient and reliable ACL repair solutions grows, the development and adoption of Acl Repair Implants are expected to play a crucial role in the expansion of the ligament augmentation market.

Product Type Analysis

The ligament augmentation market can be segmented by product type into synthetic ligament augmentation devices and biological ligament augmentation devices. Synthetic ligament augmentation devices are designed to provide immediate mechanical support to damaged ligaments. These devices are made from high-strength materials such as polyethylene terephthalate, which can mimic the natural properties of ligaments. The demand for synthetic devices is driven by their durability, ease of use, and the immediate stability they provide post-surgery.

Biological ligament augmentation devices, on the other hand, are derived from either human donors or animal sources. These devices are designed to integrate with the patient's natural tissue, promoting natural healing and reducing the risk of rejection. The main advantage of biological devices is their abilit

The Americans' Changing Lives (ACL) survey series is an ongoing, nationally representative, longitudinal study focusing especially on differences between Black and White Americans in middle and late life. These data constitute the first, second, third, fourth, fifth, and sixth waves in a panel survey covering a wide range of sociological, psychological, mental, and physical health items. Wave I of the study began in 1986 with a nation face-to-face survey of 3,617 adults ages 25 and up, with Black Americans and people aged 60 and over over-sampled at twice the rate of the others. Wave II constitutes face-to-face re-interviews in 1989 of those still alive. Survivors have been re-interviewed by telephone, and when necessary face-to-face, in 1994 (Wave III), 2001/02 (Wave IV), 2011 (Wave V), and 2019/21 (Wave VI). Please note that for Wave VI, the majority of data collection occurred in 2019, with only a small subset (n=39) of participants surveyed in 2021. ACL was designed and sought to investigate the following: (1) The ways in which a wide range of activities and social relationships that people engage in are broadly "productive," (2) how individuals adapt to acute life events and chronic stresses that threaten the maintenance of health, effective functioning, and productive activity, and (3) sociocultural variations in the nature, meaning, determinants, and consequences of productive activity and relationships. Among the topics covered are interpersonal relationships (spouse/partner, children, parents, friends), sources and levels of satisfaction, social interactions and leisure activities, traumatic life events (physical assault, serious illness, divorce, death of a loved one, financial or legal problems), perceptions of retirement, health behaviors (smoking, alcohol consumption, overweight, rest), and utilization of health care services (doctor visits, hospitalization, nursing home institutionalization, bed days). Also included are measures of physical health, psychological well-being, and indices referring to cognitive functioning. Demographic information provided for individuals includes household composition, number of children and grandchildren, employment status, occupation and work history, income, family financial situation, religious beliefs and practices, ethnicity, race, education, sex, and region of residence.

Participants’ demographic data and mechanism of injury- Chi-squared test was done to calculate p value.

Females are at greatest risk for reinjury after return to sport (RTS) following anterior cruciate ligament (ACL) reconstruction (ACLR). The reasons for these sex differences, however, remain unclear. Psychological factors such as kinesiophobia have been identified as a potential predictor for reinjury following RTS. Studies investigating kinesiophobia have identified sex differences, yet whether this holds in the ACLR population remains unknown. The purpose of this study was to examine whether there are sex differences in kinesiophobia and other psychological factors, such as readiness to RTS and self-reported pain in the ACLR population. A total of 20 participants, eleven males (23.0 ± 8.4 years, 178.9 ± 7.6 cm, 76.8 ± 10.4 kg) and 9 females (19.6 ± 5.3 years, 165.1 ± 4.0 cm, 73.2 ± 25.0 kg) voluntarily participated in this study. The Tampa Scale for Kinesiophobia (TSK-11), Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale, and self-reported pain using a visual analog scale (VAS) were administered after clearance for RTS (10.5 ± 2.3 months post-ACLR). Statistical significance was set a priori at p

The global market for ACL and PCL reconstruction devices is experiencing robust growth, driven by rising incidence of sports injuries, increasing geriatric population, and advancements in surgical techniques. The market, estimated at $2.5 billion in 2025, is projected to exhibit a Compound Annual Growth Rate (CAGR) of 7% from 2025 to 2033, reaching an estimated $4.2 billion by 2033. This growth is fueled by factors such as the increasing prevalence of knee injuries, particularly among athletes and the aging population, leading to a higher demand for effective reconstruction procedures. Technological advancements in device design, including minimally invasive surgical techniques and improved biomaterials, further contribute to market expansion. The anterior cruciate ligament (ACL) reconstruction segment currently dominates the market due to its higher incidence rate compared to posterior cruciate ligament (PCL) injuries. However, the PCL reconstruction segment is also anticipated to witness substantial growth, driven by increasing awareness and improved treatment options. Hospitals and specialized orthopedic centers represent the largest application segments, reflecting the sophisticated infrastructure and expertise required for these procedures. Geographic distribution of the market shows significant regional variations. North America currently holds the largest market share due to high healthcare expenditure, advanced medical infrastructure, and a substantial number of orthopedic specialists. However, rapidly developing economies in Asia-Pacific, particularly in China and India, are expected to witness significant growth in the coming years, driven by rising disposable incomes, increasing healthcare awareness, and improving access to advanced medical technologies. Europe also presents a substantial market opportunity, with several countries demonstrating high adoption rates of advanced surgical techniques and a growing elderly population susceptible to knee injuries. The competitive landscape is characterized by the presence of both established multinational corporations and specialized niche players, leading to intense innovation and competition in terms of product development and market penetration.

IntroductionTotal and sub-total lesions of the anterior cruciate ligament (ACL) are one of the most frequent and performance-limiting injuries to the knee joint within the active population. Early surgical management, often regarded as the primary management strategy, has recently been shown to have similar outcomes when compared with an initial rehabilitative approach followed by surgical ACL reconstruction if higher levels of functionality are needed. The primary objective of the study was to investigate the physiotherapists and orthopedic surgeons’ “coper/non-coper” screening application in the clinical management of the patient after ACL injury. Second, the authors aimed to investigate the cooperation between physiotherapists and orthopedic surgeons when dealing with patients with ACL injuries.MethodsAn online survey consisting of 12 questions on the clinical practice of the surveyed physiotherapists (n = 803) and orthopedic surgeons (n = 201), and the relation between these healthcare professionals, was distributed. The answers were stratified depending on clinical experience in dealing with ACL injuries.ResultsBoth physiotherapists and orthopedic surgeons showed a low degree of confidence and application of the “coper/non-coper” screening when managing ACL lesions. The sub-population of ACL experts reported a good level of interprofessional interaction. Nevertheless, an updated level of knowledge regarding the recent evidence on the non-surgical management of ACL lesions is still lacking.ConclusionsThe study findings indicate the need to improve the collaboration between Italian physiotherapists and orthopedic surgeons as well as their knowledge of the non-surgical approaches to ACL lesions.

Maintenance of lower limb alignment is important during surgeries involving the knee. For example, several studies have demonstrated that a higher posterior tibial plateau slope (PTPS) is a risk factor for anterior cruciate ligament (ACL) injuries. Furthermore, a PTPS ≥ 12° is a risk factor for failure of anterior cruciate ligament reconstruction. Population-specific and sex-specific differences have been reported on the PTPS in relation to different axes. Only a few studies have examined the potential risk factors associated with the geometry of the tibial plateau in relation to anterior and posterior cruciate ligament injuries. Knowledge of the PTPS, as well as the medial tibial plateau depth (MTPD), may benefit clinicians in identifying patients that may be at increased risk of graft failure following ACL reconstruction surgeries and in screening patients that may be at greater risk for cruciate ligament injuries.

As such, the PTPS in relation to the anterior tibial cortex axis (ATCA), proximal tibial anatomical axis (PTAA), and posterior tibial cortex axis (PTCA) were studied on radiographs. A sample of 480 lateral knee radiographs was examined to determine the PTPS slopes. Significant differences were only observed between weight bearing and non-weight bearing radiographs for White females (p = 0.035) when comparing the PTPS in relation to the ATCA (PTPS-ATCA) measurements. No sexual dimorphism or population differences were observed for the PTPS (p ≥ 0.05). Significant differences were observed between the PTPS -ATCA, PTPS in relation to the PTAA (PTPS-PTAA), and PTPS in relation to the PTCA (PTPS-PTCA) (p < 0.001). The age of an individual was insignificantly weakly correlated to the PTPS in relation to the ATCA (r = 0.074; p = 0.104), PTAA (r = 0.031; p = 0.499), and PTCA (r = -0.018; p = 0.686).

The MTPD was studied on an osteological sample consisting of the bilateral

examination of the tibiae of 59 individuals. No bilateral asymmetry was observed in the MTPD (p ≥ 0.05). The MTPD was shown to be sexually dimorphic (p < 0.05) for both Black and White individuals. Population differences were observed when

comparing males and females respectively for Black (p = 0.001) and White individuals (p < 0.001). The MTPD was found to be weakly correlated to the age (r = 0.066; p = 0.478), stature (m) (r = 0.204; p = 0.035), weight (kg) (r = 0.209; p = 0.031) and body mass index (BMI) (kg/m2) (r = 0.115; p = 0.242) of an individual. The correlations between the MTPD and the stature (m) and weight (kg) of an individual was significant (p < 0.05).

Fractures made up 73% of diagnoses made in the category of traumatic injuries of

bone. Ligament and meniscus pathologies were observed in 59% of patients

presenting with traumatic conditions of soft tissues. The largest proportion of patients diagnosed with degenerative conditions presented with osteophytosis (33%). A very small proportion of patients presented with dislocations and subluxations (n = 4). 63% of patients diagnosed with conditions related to the patella, patellofemoral joint and knee joint presented with knee joint narrowing. The largest proportion of surgical interventions consisted of knee replacements (51%). A small sample (n = 43) of observations was made regarding knee joint configuration.

The PTPS-ATCA, PTPS-PTAA, and PTPS-PTCA was shown to be highly variable in

the South African population. A significant difference was observed between weight bearing and non-weight bearing radiographs in the White female sample (p = 0.035). This difference, however, was small and may not be clinically relevant. No populationspecific or sex-specific differences were observed in the PTPS-ATCA, PTPS-PTAA, or PTPS-PTCA. Significant differences were observed for the PTPS-ATCA, PTPS-PTAA, and PTPS-PTCA in the South African population (p < 0.001). Sexual dimorphism exists for the MTPD in the Black and White South African populations with a greater depth of concavity being observed in males than in females (p = 0.001 [Black population] and p < 0.001 [White population]). No population-specific differences were observed for the MTPD when White and Black populations were compared for females (p = 0.768) or males (p = 0.633).