Document Title: Flynn-AJSM-Jan05.shtml
Article Title: The Familial Predisposition Toward Tearing the Anterior Cruciate Ligament -- A Case Control Study
Authors: R. Kevin Flynn, MSc, Cheryl L. Pedersen, MSc, Trevor B. Birmingham, PhD, Alexandra Kirkley, MD, Dianne Jackowski, MSc and Peter J. Fowler, MD.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: January 2005
Volume 33, pages 23-28
Keywords: survey, questionnaire, pattern analysis, anterior cruciate ligament (ACL) tearing, injury, disability, familial predisposition, genetic predisposition, causes, risk factor, case control.

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Comments: This study shows that there is clearly a genetic proclivity towards ACL tearing. Note that genetic make-up influences anatomy (e.g. knock-kneedness), joint laxity (e.g. joints which hyperextend greatly), and other factors. Although determining all the genetically-related causes of ACL-tearing predilection will not be easy, it stands to reason that if everyone in your family except yourself has torn at least one ACL, and if you are about to sign up for a knee-demanding sports league (e.g. soccer, basketball, volleyball), then you might wish either to consider pursuing different sports (i.e. ones which are not associated with high ACL-injury risk) or to consult a knee-experienced physiotherapist for training advice and then perhaps pursue a knee-injury-prevention training program (e.g. Cincinnati Sportsmetrics). Note that such knee-injury-prevention training is also helpful from the standpoint of improved athletic performance, at it will boost one's jumping height and sprinting speed. Note, too, that genetic predispositions to knee-ligament injuries can also arise as a consequence of inheritable traits such as knock-kneedness, loose-jointedness, or vestibular-system firmware problems.

ABSTRACT

Purpose: A study of 171 surgical cases and 171 matched controls was conducted to investigate whether a familial predisposition toward tearing the anterior cruciate ligament of the knee exists.

Study Design: Case control study; Level of evidence, 3.

Methods: Patients who were diagnosed with an anterior cruciate ligament tear were matched by age (within 5 years), gender, and primary sport to subjects without an anterior cruciate ligament tear. All 342 subjects completed a questionnaire detailing their family history of anterior cruciate ligament tears.

Results: When controlling for subject age and number of relatives, participants with an anterior cruciate ligament tear were twice as likely to have a relative (first, second, or third degree) with an anterior cruciate ligament tear compared to participants without an anterior cruciate ligament tear (adjusted odds ratio = 2.00; 95% confidence interval, 1.19–3.33). When the analysis was limited to include only first-degree relatives, participants with an anterior cruciate ligament tear were slightly greater than twice as likely to have a first-degree relative with an anterior cruciate ligament tear compared to participants without an anterior cruciate ligament tear (adjusted odds ratio = 2.24; 95% confidence interval, 1.24–4.00).

Conclusions: Findings are consistent with a familial predisposition toward tearing the anterior cruciate ligament.

Clinical Relevance: Future research should concentrate on identifying the potentially modifiable risk factors that may be passed through families and developing strategies for the prevention of anterior cruciate ligament injuries.

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