ArticleThe American journal of sports medicine2021
The Anterior Cruciate Ligament Can Become Hypertrophied in Response to Mechanical Loading: A Magnetic Resonance Imaging Study in Elite Athletes.
Article in The American journal of sports medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.
- Does mechanical loading restore ligament biomechanics after injury? A systematic review of studies using animal models.BMC musculoskeletal disorders · 2023Pooled it
- An Evidence-Based and Mechanistic Approach to Reducing the Risk of Anterior Cruciate Ligament Injury: An Exercise and Sport Science Australia Position Statement.Sports medicine (Auckland, N.Z.) · 2026Article
- Understanding Anterior Cruciate Ligament Adaptation: Structural, Mechanical, and Healing Considerations.Sports medicine (Auckland, N.Z.) · 2026Review
- Adding a weight to constrain the trunk increases knee joint kinetics during sidestep cutting in female athletes.Scientific reports · 2026Article
- Female Anterior Cruciate Ligaments Exhibit a Muted Mechanobiological Response to Mechanical Loading.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2025Article
- Rethinking Acute Sports Injuries: Evidence for an Overuse Mechanism in Hamstring and ACL Injuries.Scandinavian journal of medicine & science in sports · 2025Review
- Cross-species analysis of genetic architecture and polygenic risk scores for non-contact ACL rupture in dogs and humans.Communications biology · 2025Article
- Anatomical Tissue Engineering of the Anterior Cruciate Ligament Entheses.International journal of molecular sciences · 2023Review
- ACL Research Retreat IX Summary Statement: The Pediatric Athlete, March 17-19, 2022; High Point, North Carolina.Journal of athletic training · 2022Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundEvidence, 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. PURPOSE: 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. STUDY
designCross-sectional study; Level of evidence, 3.
methodsWe recruited 52 figure skaters and springboard divers (46 female and 6 male; mean age, 20.2 ± 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- and oblique sagittal-plane 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
resultsA significantly larger ACL CSA (mean difference, 4.9% ± 14.0%;
conclusionAthletes 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 "trained" in athletes. If done correctly, it could help lower the risk for ACL injuries.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.