{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T04:53:13Z","timestamp":1789102393562,"version":"build-2803163510"},"reference-count":44,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100007270","name":"university of michigan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007270","id-type":"DOI","asserted-by":"publisher"}]},{"name":"MedSport"},{"DOI":"10.13039\/100000069","name":"national institute of arthritis and musculoskeletal and skin diseases","doi-asserted-by":"publisher","award":["R01 AR054821"],"award-info":[{"award-number":["R01 AR054821"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Evidence, mainly from animal models, suggests that exercise during periods of pubertal growth can produce a hypertrophied anterior cruciate ligament (ACL) and improve its mechanical properties. In humans, the only evidence of ACL hypertrophy comes from a small cross-sectional study of elite weight lifters and control participants; that study had methodological weaknesses and, thus, more evidence is needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To investigate bilateral differences in the ACL cross-sectional area (CSA) for evidence of unilateral hypertrophy in athletes who have habitually loaded 1 leg more than the other.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cross-sectional study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We recruited 52 figure skaters and springboard divers (46 female and 6 male; mean age, 20.2 \u00b1 2.7 years) because the former always land\/jump on the same leg while the latter always drive the same leg into the board during their hurdle approach. Sport training for all participants began before puberty and continued throughout as well as after. Using oblique axial\u2013 and oblique sagittal\u2013plane magnetic resonance imaging, we measured the ACL CSA and the anteroposterior diameter of the patellar tendon, respectively. In addition, isometric and isokinetic knee extensor and flexor peak torques were acquired using a dynamometer. Bilateral differences in the ACL CSA, patellar tendon diameter, and knee muscle strength were evaluated via 2-sided paired-samples t tests. Correlations between the bilateral difference in the ACL CSA and age of training onset as well as between the bilateral difference in the ACL CSA and years of training were also examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A significantly larger ACL CSA (mean difference, 4.9% \u00b1 14.0%; P = .041), as well as patellar tendon diameter (mean difference, 4.7% \u00b1 9.4%; P = .002), was found in the landing\/drive leg than in the contralateral leg. The bilateral difference in the ACL CSA, however, was not associated with the age of training onset or years of training. Last, the isometric knee flexor peak torque was significantly greater in the landing\/drive leg than the contralateral leg (mean difference, 14.5% \u00b1 33.8%; P = .019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Athletes who habitually loaded 1 leg more than the other before, during, and after puberty exhibited significant unilateral ACL hypertrophy. This study suggests that the ACL may be able to be \u201ctrained\u201d in athletes. If done correctly, it could help lower the risk for ACL injuries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465211012354","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T09:11:22Z","timestamp":1626253882000},"page":"2371-2378","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["The Anterior Cruciate Ligament Can Become Hypertrophied in Response to Mechanical Loading: A Magnetic Resonance Imaging Study in Elite Athletes"],"prefix":"10.1177","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0333-5514","authenticated-orcid":false,"given":"M\u00e9lanie L.","family":"Beaulieu","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeleine 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California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Ashton-Miller","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward M.","family":"Wojtys","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, 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