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Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A deep lateral femoral notch (LFN) on lateral radiographs is indicative of ACL injury. Prior studies have suggested that a deep LFN may also be a sign of persistent rotatory instability and a concomitant lateral meniscus tear. Therefore, the purpose of this study was to evaluate the relationship between LFN depth and both quantitative measures of rotatory knee instability and the incidence of lateral meniscus tears. It was hypothesized that greater LFN depth would be correlated with increased rotatory instability, quantified by lateral compartment translation and tibial acceleration during a quantitative pivot shift test, and incidence of lateral meniscus tears.

Methods

ACL-injured patients enrolled in a prospective ACL registry from 2014 to 2016 were analyzed. To limit confounders, patients were only included if they had primary ACL tears, no concurrent ligamentous or bony injuries requiring operative treatment, and no previous knee injuries or surgeries to either knee. Eighty-four patients were included in the final analysis. A standardized quantitative pivot shift test was performed pre-operatively under anesthesia in both knees, and rotatory instability, specifically lateral compartment translation and tibial acceleration, was quantified using tablet image analysis software and accelerometer sensors. Standard lateral radiographs and sagittal magnetic resonance images (MRI) of the injured knee were evaluated for LFN depth.

Results

There were no significant correlations between LFN depth on either imaging modality and ipsilateral lateral compartment translation or tibial acceleration during a quantitative pivot shift test or side-to-side differences in these measurements. Patients with lateral meniscus tears were found to have significantly greater LFN depths than those without on conventional radiograph and MRI (1.0 vs. 0.6 mm, p < 0.05; 1.2 vs. 0.8 mm, p < 0.05, respectively).

Conclusion

There was no correlation between lateral femoral notch depth on conventional radiographs or MRI and quantitative measures of rotatory instability. Concomitant lateral meniscus injury was associated with significantly greater LFN depth. Based on these findings, LFN depth should not be used as an indicator of excessive rotatory instability, but may be an indicator of lateral meniscus injury in ACL-injured patients.

Level of evidence

Prognostic level IV.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Center for Sports Medicine, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S Water Street, Pittsburgh, PA, 15203, USA

    Ajay C. Kanakamedala, Jeremy M. Burnham, Marcin Kowalczuk, Adam Popchak, James Irrgang, Freddie H. Fu & Volker Musahl

  2. Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, 51109, Cologne, Germany

    Thomas R. Pfeiffer

  3. Department of Orthopaedic Sports Medicine, Technical University Munich, 81675, Munich, Germany

    Elmar Herbst

Authors
  1. Ajay C. Kanakamedala
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  2. Jeremy M. Burnham
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  3. Thomas R. Pfeiffer
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  4. Elmar Herbst
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  5. Marcin Kowalczuk
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  6. Adam Popchak
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  7. James Irrgang
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  8. Freddie H. Fu
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  9. Volker Musahl
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Corresponding author

Correspondence to Volker Musahl.

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Conflict of interest

All authors declare that they have no conflict of interest.

Funding

There was no external source of funding for this study.

Ethical approval

Approval was obtained from the University of Pittsburgh Institutional Review Board (PRO09030172).

Informed consent

Informed consent was obtained from all participants included in the study.

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Cite this article

Kanakamedala, A.C., Burnham, J.M., Pfeiffer, T.R. et al. Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis. Knee Surg Sports Traumatol Arthrosc 26, 1399–1405 (2018). https://doi.org/10.1007/s00167-017-4770-9

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  • DOI: https://doi.org/10.1007/s00167-017-4770-9

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