 ACL injuries can occur in numerous ways. While it isn't possible to predict when they happen, certain anatomical features are known to put some people at higher risk than others. But are the thresholds for these so-called bony risk factors too high? An analysis of healthy individuals reported in the American Journal of Sports Medicine suggests they might be. Researchers analyzed three-dimensional CT scans for 382 healthy white and Asian participants. Among the bony risk factors they assessed were interconjular notch width, notch width index, lateral femoral condylar index, medial posterior platotibial angle, and lateral posterior platotibial angle. According to published thresholds for these factors, 15 to 62% of people in this healthy population were at risk of sustaining an ACL injury, and fewer than 15% had no bony risk factor. These rates raised the question of the specificity and sensitivity of current anatomical thresholds in identifying high-risk patients. Further analysis revealed differences based on sex and ethnicity. The interconjular notch width was wider in men, and compared with white participants, Asian participants had a narrower interconjular notch width, higher lateral femoral condylar index, and lower medial posterior platotibial angle. Understanding how bony risk factors vary based on sex and ethnicity and across different populations could yield better predictions of which patients are truly at risk of sustaining ACL injuries and experiencing ACL reconstruction failures.