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The space available for the anterior cruciate ligament in the intercondylar notch is less in patients with ACL injury

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to determine if a difference exists in the relationship between the femoral intercondylar notch volume, and the volumes of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) in ACL injured patients and healthy subjects.

Methods

Intact knees of 19 healthy subjects and bilateral knees of 18 ipsilateral ACL reconstructed patients were scanned using 3-tesla high-resolution magnetic resonance imaging. The intercondylar notch, ACL, PCL and hamstring graft were segmented using three-dimensional (3D) processing software. The native intercondylar notch, ACL, and PCL volumes were compared between both groups. The volumes of native ACL and graft were compared in ACL injured patients.

Results

The following volumes showed no significant differences between the ACL injured group and control group; intercondylar notch (9.9 ± 2.3 vs 9.6 ± 1.7 cm3), ACL (2.4 ± 0.7 vs 2.4 ± 0.6 cm3) and PCL (3.9 ± 1.0 vs 3.4 ± 0.8 cm3), and the ratio of the ACL to the intercondylar notch (24.6 ± 5.0 vs 25.4 ± 2.9%). There was a significant difference in the ratio of PCL to the intercondylar notch (39.1 ± 4.3 vs 35.9 ± 4.9%, p = 0.023). The graft was significantly larger than native ACL volume (3.0 ± 0.7 vs 2.4 ± 0.7 cm3, p = 0.012).

Conclusions

The ratio of the PCL volume in the femoral intercondylar notch was higher in the ACL injured group compared to the healthy control group, despite the ratio of ACL volume in the femoral intercondylar notch being similar in both groups. A greater awareness of the potentially limited space for the graft alongside the PCL within the femoral intercondylar notch may allow surgeons a more informed choice of graft type and size.

Level of evidence

IV.

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Abbreviations

MRI:

Magnetic resonance imaging

ACL:

Anterior cruciate ligament

PCL:

Posterior cruciate ligament

BMI:

Body mass index

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Funding

This study received no funding.

Author information

Authors and Affiliations

  1. Sydney Orthopaedic Research Institute, Level 1, 445 Victoria Avenue, Chatswood, Sydney, NSW, Australia

    Takeshi Oshima, Sven Putnis, Samuel Grasso & David Anthony Parker

  2. Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan

    Takeshi Oshima

  3. Avon Orthopaedic Centre, Bristol, UK

    Sven Putnis

  4. The University of Sydney, Sydney, Australia

    Samuel Grasso & David Anthony Parker

Authors
  1. Takeshi Oshima
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  2. Sven Putnis
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  3. Samuel Grasso
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  4. David Anthony Parker
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Contributions

Conceptualization: TO. Project administration and Supervision: DAP. Investigation, Formal analysis and Validation: TO, SP and SG. Writing-original draft: TO. Writing-review and editing: SP, SG and DAP.

Corresponding author

Correspondence to Takeshi Oshima.

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Conflict of interest

The authors declare that they have no conflict of interest. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical approval

The study design was approved by the Human Research Ethics Committee of the Northern Sydney Local Health District (HREC/17/HAWKE/140).

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

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Oshima, T., Putnis, S., Grasso, S. et al. The space available for the anterior cruciate ligament in the intercondylar notch is less in patients with ACL injury. Knee Surg Sports Traumatol Arthrosc 28, 2105–2115 (2020). https://doi.org/10.1007/s00167-020-05921-w

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  • DOI: https://doi.org/10.1007/s00167-020-05921-w

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