A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury (original) (raw)
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Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2011
Purpose: The aim of this study was to determine whether individuals with anterior cruciate ligament (ACL) injuries have smaller notch volumes than uninjured subjects. A secondary aim was to determine the correlation between intraoperative 2-dimensional (2D) notch measurements, patient demographic factors, and notch volume. Methods: Manual digital tracings of the femoral intercondylar notch perimeter were performed on axial magnetic resonance images to calculate 3-dimensional (3D) notch volume. Notch volume was compared between 50 patients with ACL injury and 50 patients without ACL injury (control subjects). From the 50 patients with ACL injury, intraoperative 2D measurements of the notch were taken. These 2D measurements and patient demographic factors were correlated to 3D notch volume, by use of the Pearson correlation coefficient. In addition, notch size was compared between men and women. All group comparisons were performed by use of unpaired t tests. Results: The notch volume was larger (6.5 Ϯ 1.7 cm 3 [mean Ϯ SD]) for the group with ACL injury compared with control subjects (5.9 Ϯ 1.4 cm 3 ); this difference approached statistical significance (P ϭ .054). There were no significant correlations between the 2D dimensions and the 3D notch volume. Larger notch volumes were significantly correlated with increased subject height (r ϭ 0.636, P Ͻ .001) and weight (r ϭ 0.364, P Ͻ .001) but not body mass index (P ϭ .269). Male patients had significantly larger notch volumes than female patients (P Ͻ .001). Conclusions: Contrary to our hypothesis, there was a trend toward larger notch volumes in patients with ACL injury compared with patients without ACL injury. Intraoperative notch measurements did not correlate with 3D notch volume. Notch volume was related to patient height, weight, and gender but not body mass index. Level of Evidence: Level III, case-control study.
Journal of Biomechanics, 2010
The role played by anatomic factors in ACL injury remains elusive. In this study, objective methods were used to characterize ACL volume, tibial slopes, and notch geometry from ACL-injured and matched control subjects. The study tested four hypotheses: 1) the medial tibial plateau slope is steeper posteriorly in the injured group compared to the non-injured group, 2) the lateral tibial plateau slope is steeper posteriorly in the injured group compared to the non-injured group, 3) the femoral intercondylar notch dimensions are smaller in the injured group compared to the non-injured group and 4) the ACL volume, tibial plateau slopes and intercondylar notch dimensions are all independent of each other. Fifty-four subjects were divided into two groups, those who had suffered a non-contact ACL injury and those who still had two healthy ACLs, matched to the injured subjects by gender, age, height and weight. The lateral tibial plateaus in the uninjured contralateral knees of the injured subjects had a significantly steeper posterior slope (1.8° vs. −0.3°), a factor that potentially contributed to the ACL injury in the opposite knee. The intercondylar notch dimensions were found to be smaller in the injured subjects, potentially putting the ACL at risk of impingement, and intercondylar notch volume was correlated to ACL volume (r=0.58). Discriminant analysis showed that the notch width at the inlet was the best single predictor of ACL injury.
The Journal of bone and joint surgery. British volume, 2011
It has been suggested that an increased posterior tibial slope (PTS) and a narrow notch width index (NWI) increase the risk of anterior cruciate ligament (ACL) injury. The aim of this study was to establish why there are conflicting reports on their significance. A total of fifty patients with a ruptured ACL and 50 patients with an intact ACL were included in the study. The group with ACL rupture had a statistically significantly increased PTS (p < 0.001) and a smaller NWI (p < 0.001) than the control group. When a high PTS and/or a narrow NWI were defined as risk factors for an ACL rupture, 80% of patients had at least one risk factor present; only 24% had both factors present. In both groups the PTS was negatively correlated to the NWI (correlation coefficient = -0.28, p = 0.0052). Using a univariate model, PTS and NWI appear to be correlated to rupture of the ACL. Using a logistic regression model, the PTS (p = 0.006) and the NWI (p < 0.0001) remain significant risk fact...
2015
Purpose: This study was done to determine whether a) there is a correlation between the Notch Width Index (NWI) and notch volume, as measured by Magnetic Resonance Imaging (MRI), in patients with ACL-injured and non-ACL injured knees, b) there is a difference in NWI between patients with and without anterior cruciate ligaments tear, c) there is a relationship between ACL diameter, angle of ACL inclination and ACL injury and d) there are differences in distal femur morphology between the ACL-injured and non-ACL injured knees. Materials and methods: In this study, 59 ACL-injured patients and 59 match-control ACL-intact patients were enrolled. MRI was used to measure the notch width, notch height and condylar widths. The thickness of ACL and ACL angle of inclination were also measured. Results: Statistically, Notch Width Index (NWI) (0.47 +/- 0.07 vs 0.43+/-0.05, p <0.05) and Medial-condyle tolateral condyle ratio (M:L ratio) ( 1.07 +/- 0.11 vs 1.02 +/- 0.09, p = 0.023) were all sig...
IP innovative publication pvt. ltd, 2019
Introduction: It has been proposed that a narrow intercondylar notch may increase the risk of anterior cruciate ligament (ACL) injury but the data are conflicting. We performed this cross-sectional study to investigate the significance of Notch width index for ACL tears. Materials and Methods: All adult patients with knee problems, who were referred to the Department of Orthopaedics Amrita Institute of Medical Sciences, Kochi and underwent MRI knee, from August 2016 to August 2018, were included in this study. Axial and longitudinal MRI was performed using 1.5 Tesla or 3 Tesla MRI with the patient's knee in an extended position. In all patients, the femoral notch Index was measured. Patient were divided into 2 groups depending on their NWI (<0.2 or >0.2) Because of the effect of osteoarthritis in decreasing the intercondylar notch index, cases with obvious osteoarthritis were not included in the study. To test the statistical significance of the difference in Femoral Notch Width Index with respect to gender Student’s t test was used. To test the statistical significance of difference in percentage’s with respect to ACL tear (yes or no) and Femoral Notch Width Index(<0.2 or >0.2) Chi-square test was used. Results: 300 patients were enrolled in the study. The age range was 20-50 years. We found that group 1 (<0.2 NWI) has higher percentage of ACL tear as compared to group 2 (>0.2 NWI). We also found that male’s have a higher NWI as compared to females (p value <0.001). Conclusion: ACL tear was found to be higher among the patients with NWI < 0.2 as compared to patients with NWI >0.2 which is statistically significant.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 1999
We assessed the anatomy of the anterior cruciate ligament (ACL) and femoral intercondylar notch on cryosections from one cadaveric knee specimen in the coronal oblique plane oriented parallel to the intercondylar roof. We determined the course of the ACL, the widths of the cruciate ligaments at intersection, and the intercondylar notch configuration on coronal oblique plane magnetic resonance images in 51 adult cruciate ligament-intact knees (25 women, 26 men; age range, 16 to 47 years). The intercondylar notch widths were measured at the notch entrance, at the intersection of the ACL and posterior cruciate ligament (PCL), and at the notch outlet. In the coronal oblique plane, the ACL exhibited a diagonal course from the central and medial part of the anterior intercondylar area of the tibia distally, across the lateral third of the intercondylar notch, to the intercondylar surface of the lateral femoral condyle proximally. At the cruciate ligament intersection, the absolute widths of the ACLs measured on average 6.1 Ϯ 1.1 mm in men and 5.2 Ϯ 1.0 mm in women representing 31.9% and 31.1% of the ACL/central intercondylar notch width ratios. The absolute widths of the PCLs measured on average 9.6 Ϯ 1.3 mm in men and 8.5 Ϯ 1.3 mm in women representing 50.4% and 51.4% of PCL/central intercondylar notch width ratios. On average for both groups, men and women, the absolute widths of the PCLs were significantly larger than the absolute widths of the ACLs. However, the relative widths of the cruciate ligaments with respect to corresponding intercondylar notch widths were not significantly different. In the coronal oblique plane, the intercondylar notch widths showed on average a significant decrease from posterior to intersection and from intersection to anterior. At notch outlet, the mean notch width measured 21.4 mm in men and 18.5 mm in women. At intersection, the mean notch width measured 19.1 mm in men and 16.6 mm in women. At notch entrance, the notch width measured 14.6 Ϯ 1.8 mm in men and 12.7 Ϯ 2.1 mm in women. We recommend magnetic resonance tomography of the knee in the coronal oblique plane oriented parallel to the intercondylar roof as the imaging modality of choice to visualize accurately the anatomic diagonal course of the ACL and its relation to the intercondylar notch and posterior cruciate ligament complex.
International Journal of Health Sciences (IJHS), 2022
Background: Knee joint is one of the largest joints in the body which solely is responsible for supporting the foremost weight of the body. Anterior Cruciate Ligament plays a primary role in stabilizing the knee joints, which also increases its chances of risk. Therefore, in comparison to other ligaments Anterior Cruciate Ligament injury can more commonly lead to knee instability. Aims & Objectives. To study and correlate femoral intercondylar notch width and shape on Magnetic Resonance Imaging in Anterior Cruciate Ligament injuries. Further, to study relationship of posterior tibial 6592 slopes of medial and lateral plateaus and depth of the medial tibial plateau with Anterior Cruciate Ligament injury on Magnetic Resonance Imaging. Materials & Methods: Patients with clinical suspicion of Anterior Cruciate Ligament injury undergoing Magnetic Resonance Imaging knee at M.S. Ramaiah hospitals, Bengaluru in the period of November 2019 to June 2021. Medial and Lateral Tibial Plateau Slope, Medial Tibial Plateau Depth, Notch Width Index were recorded along with other data such as age, gender, etiology, Lachman test, presence or absence of tears, shape of notch and other relevant data. All the qualitative or categorized variables like gender, age group, presence or absence of tears, shape of notch were presented using frequency and percentage. Results: Mean age of the patients in cases and controls in our study was found to be 34.03 ± 13.91 and 39.26 ± 13.79 years with male predominance. Mean value of medial tibial plateau depth in cases and controls was found to be 2.41 ± 0.316 and 2.58 ± 0.36 respectively and the mean value of tibial plateau slope in cases and controls was found to be 8.55 ± 1.07 and 8.03 ± 0.88 and the mean value of tibial condyle angle lateral in cases and controls was found to be 6.77 ± 1.22 and 6.19 ± 0.85 respectively. 25 cases were positive for LACHMAN TEST with mean value of Notch Width Index in cases and controls was found to be 0.28 ± 0 and 0.3 ± 0 respectively with the shape of ICN in the form of A, U & OMEGA was found to be seen in 11, 7 and 17 cases respectively. Conclusion: A clear male predilection with instability and valgus involvement was observed in majority of the patients. We also found that there was narrowing of the notch width index which was statistically significant in comparison with the control group. Patients with Anterior Cruciate Ligament injury, had decreased notch width index and medial tibial plateau depth whereas there was an increase in the tibial condyle angle medially as well as laterally.