{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T21:11:24Z","timestamp":1793481084127,"version":"4.5.0"},"reference-count":49,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Both tibial spine fractures (TSFs) and anterior cruciate ligament (ACL) tears result in functional loss of knee stability. Nonetheless, it remains unclear why some patients sustain ACL tears, whereas others have TSFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To identify the common morphological risk factors for pediatric ACL tears and TSFs and to determine the morphological differences between them using multiplanar reconstruction of magnetic resonance imaging (MRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Age- and sex-matched participants (159 total [53 ACL tears, 53 TSFs, and 53 controls]) aged &lt;18 years who visited a pediatric tertiary-care center for ACL tears, TSFs, or anterior knee pain from March 2009 to April 2023 were included. Each group comprised 41 male and 12 female participants. Data on demographic characteristics and estimated bone age based on the knee MRI atlas were retrospectively collected, and various knee morphological parameters were evaluated using multiplanar reconstruction of MRI. Parameters showing significant differences among the 3 groups were selected as independent variables for multivariable multinomial logistic regression analysis, with the groups as dependent variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean chronological age at the time of MRI was 13.2 \u00b1 2.3 years. Height, weight, body mass index, bone age, articular medial tibial slope, and bony medial tibial slope did not differ among the groups. Articular lateral tibial slope was independently associated with the occurrence of both ACL tears (relative risk ratio [RRR], 1.42 [95% confidence interval (CI), 1.16-1.74];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001) and TSFs (RRR, 1.33 [95% CI, 1.10-1.62];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .004). A high notch width index was a protective factor against ACL tears (RRR, 0.86 [95% CI, 0.77-0.96];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .006) but not against TSFs (RRR, 1.01 [95% CI, 0.91-1.12];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .848).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A high articular lateral tibial slope was a common risk factor for ACL tears and TSFs. Patients with ACL tears had a narrower intercondylar notch than those with TSFs and controls.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465251334120","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T07:07:54Z","timestamp":1745824074000},"page":"1596-1605","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Morphological Risk Factors for Pediatric Anterior Cruciate Ligament Tears and Tibial Spine Fractures"],"prefix":"10.1177","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4154-7964","authenticated-orcid":false,"given":"Chang Ho","family":"Shin","sequence":"first","affiliation":[{"name":"Seoul National University Children\u2019s Hospital, Seoul, Republic of Korea"},{"name":"Seoul National University College of Medicine, Seoul, Republic of Korea"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3270-7708","authenticated-orcid":false,"given":"Akbar N.","family":"Syed","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan E.","family":"Swanson","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Todd R.","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soroush","family":"Baghdadi","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles, Los Angeles, California, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Aristides I.","family":"Cruz","sequence":"additional","affiliation":[{"name":"Hasbro Children\u2019s Hospital, Providence, Rhode Island, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Henry B.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Scottish Rite for Children, Dallas, Texas, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter D.","family":"Fabricant","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, New York, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel W.","family":"Green","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, New York, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Kerrigan","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario, Ottawa, Ontario, Canada"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Kirby","sequence":"additional","affiliation":[{"name":"Austin Health, Heidelberg, Victoria, Australia"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mininder","family":"Kocher","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indranil V.","family":"Kushare","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital, Houston, Texas, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Jay Lee","sequence":"additional","affiliation":[{"name":"Johns Hopkins Hospital, Baltimore, Maryland, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P.","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Nationwide Children\u2019s Hospital, Columbus, Ohio, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"McKay","sequence":"additional","affiliation":[{"name":"Texas Children\u2019s Hospital, Houston, Texas, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shital N.","family":"Parikh","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"},{"name":"Investigation performed at Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeraj M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Ann &amp; Robert H. 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