{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T17:07:37Z","timestamp":1778951257323,"version":"3.51.4"},"reference-count":49,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"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":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recent studies suggest that increased tibiofemoral (TF) rotation elevates the risk of anterior cruciate ligament (ACL) reconstruction failure, with a proposed threshold of 4.5\u00b0 of internal rotation (IR). However, the role of TF rotation in primary ACL injury remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose\/Hypothesis:<\/jats:title>\n                    <jats:p>The purpose was to evaluate whether axial TF malalignment, as reflected by the TF axial rotation angle and tibial tubercle\u2013trochlear groove (TTTG) distance, is associated with primary ACL injury in professional soccer players. It was hypothesized that increased internal TF rotation is associated with ACL injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective review was performed on a consecutive series of professional soccer players who underwent ACL reconstruction between January 2012 and August 2024. Inclusion criteria were primary ACL injury and availability of preinjury magnetic resonance imaging (MRI). Cases were matched 2:1 by age with controls, who were players who underwent meniscal surgery during the same period and had no history of ACL injury. The groups were compared in terms of age, TTTG distance, medial and lateral posterior tibial slope, resting knee flexion, and axial TF rotation during MRI acquisition. All MRI scans were independently reviewed by 2 musculoskeletal radiologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Twenty-four professional soccer players (mean \u00b1 SD age, 25.3 \u00b1 4.2\u2009years) with MRI and arthroscopy-confirmed primary ACL injuries were included. The control group consisted of 48 players (mean age, 23.6 \u00b1 3.3\u2009years) who had intact ACLs confirmed via MRI and arthroscopy and underwent meniscal surgery. No statistically significant differences were observed between groups for age, medial and lateral posterior tibial slope, knee flexion during MRI, or axial TF rotation (IR, 6.7\u00b0\u00b1 5.8\u00b0 vs 4.3\u00b0\u00b1 5.9\u00b0; all,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; .05). The prevalence of resting axial TF rotation \u22654.5\u00b0 of IR was also not significantly different between groups (70.8% vs 66.7%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .721). The TTTG distance was significantly smaller in players with ACL injuries (8.9 \u00b1 3.4\u2009mm vs 10.9 \u00b1 4.2\u2009mm;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .050) but did not reach statistical significance when adjusted for knee flexion (odds ratio, 1.15; 95% CI, 1.00-1.32;\u2009\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .059). There was no difference in resting axial TF rotation and TTTG between pre- and postinjury MRI scans in players with ACL injury.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In this cohort of professional soccer players, TF axial rotation was not significantly associated with primary ACL injury. Although not statistically significant, the association between a smaller TTTG distance and ACL injury may reflect an underlying anatomic predisposition related to IR malalignment. Notably, neither resting axial TF rotation nor TTTG distance differed before and after injury, indicating that these features are likely inherent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671261419362","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T16:34:27Z","timestamp":1778517267000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Axial Tibiofemoral Rotation on Primary ACL Injury in Professional Soccer Players: A Matched-Cohort Analysis"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4063-5815","authenticated-orcid":false,"given":"Jakob","family":"Ackermann","sequence":"first","affiliation":[{"name":"Fortius Clinic, FIFA Medical Centre of Excellence, London, United Kingdom"},{"name":"Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9293-8922","authenticated-orcid":false,"given":"Mary","family":"Jones","sequence":"additional","affiliation":[{"name":"Fortius Clinic, FIFA Medical Centre of Excellence, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon V.","family":"Ball","sequence":"additional","affiliation":[{"name":"Fortius Clinic, FIFA Medical Centre of Excellence, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adnan S.","family":"Kabeer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3675-079X","authenticated-orcid":false,"given":"Prashant","family":"Bamania","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Watura","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin C.","family":"Lee","sequence":"additional","affiliation":[{"name":"Fortius Clinic, FIFA Medical Centre of Excellence, London, United Kingdom"},{"name":"Division of Surgery and Interventional Science, University College London, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6756-2751","authenticated-orcid":false,"given":"Andy","family":"Williams","sequence":"additional","affiliation":[{"name":"Fortius Clinic, FIFA Medical Centre of Excellence, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-021-03947-4"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-017-4494-x"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ksa.12434"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465241235949"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520959619"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513484895"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671231180860"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2020.03.027"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546512464691"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2009.060582"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.asmr.2023.100839"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517745268"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515617742"},{"issue":"5","key":"e_1_3_2_15_2","first-page":"423","article-title":"The measurement of the tibial tuberosity. 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