Abstract
Purpose
To determine the relationship between femoral notch morphology, femoral notch width index and anterior cruciate ligament tears using magnetic resonance imaging of the knee.
Methods
This retrospective study was conducted on 560 patients who had magnetic resonance imaging (MRI) examinations of the knee between February 2010 and June 2011. Two morphological changes were investigated: the shape of the femoral notch and its width index. The femoral notch shape was classified into one of three types: Type A, which is a narrow (Stenotic) notch that appears narrowed from the base to the midsection as well as at the apex; Type U, in which the midsection does not taper, allowing for a wider contour to the notch than Type A; and Type W, which has the characteristics of Type U but with two apparent apices. The femoral notch width index was calculated as a ratio of central notch width and transcondylar or intercondylar width; values of 0.270 or more were considered as normal and values of 0.269 or less were considered as below normal. These measurements were correlated with the presence or absence of anterior cruciate ligament (ACL) tears.
Results
Of 560 patients, there were 280 cases of ACL tear. Of the 560 patients, 240 had a Type A femoral notch shape and 320 had a Type U or W femoral notch shape. Of those with Type A, 73 % (176 patients) had ACL tears, and of those with Type U or W, 32 % (104 patients) had ACL tears. Statistical analysis showed that the Type A notch correlated with ACL injury (p value < 0.0001). The femoral notch width index was low in 37 % (88 subjects) with Type A notch compared with 27.5 % (88 subjects) with Type U or W notches. Of the 280 subjects with ACL tear, only 17 % (48 patients) had a reduced femoral notch index.
Conclusion
This study showed that the Type A femoral notch appears to be a risk factor for ACL injury, whereas a reduced notch index has no significant correlation to ACL injury.
Level of evidence
III.
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References
Alentorn GE, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, Cugat R (2009) Prevention of non contact anterior cruciate ligament injury in soccer players Part I: mechanism of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 17:705–729
Alizadeh A, Kiavash V (2008) Mean intercondylar notch width index in cases with and without anterior cruciate ligament tears. Iran J Radiol 5:205–208
Anderson AF, Lipscomb AB, Liudahl KJ, Addlestone RB (1987) Analysis of the intercondylar notch by computed tomography. Am J Sports Med 15:547–552
Dienst M, Schneider G, Altmeyer K, Voelkering K, Georg T, Kramann B, Kohn D (2007) Correlation of intercondylar notch cross sections to the ACL size: a high resolution MR tomographic in vivo analysis. Arch Orthop Trauma Surg 127:253–260
Domzalski M, Grzelak P, Gabos P (2010) Risk factors for anterior cruciate ligament injury in skeletally immature patients. Analysis of intercondylar notch width using magnetic resonance imaging. Int Orthop 34:703–707
Fung DT, Zhang LQ (2003) Modeling of ACL impingement against the intercondylar notch. Clin Biomech 18:933–941
Gregory CF, Maish DR (1997) Knee ligaments injury: epidemiology, mechanism, diagnosis and natural history. In: Stoller DW (ed) Magnetic resonance imaging in orthopedic and sports medicine, 2nd edn. Lippincott-Raven, Philadelphia, pp 621–623
Good L, Odensten M, Gillquist J (1991) Intercondylar notch measurements with specific reference to anterior cruciate ligament surgery. Clin Orthop Relat Res 63:185–189
Harman KG, Ireland ML (2000) Gender differences in non contact anterior cruciate ligament injuries. Clin Sports Med 19:287–302
Herzog RJ, Silliman JF, Hutton K, Rodkey WG, Steadman JR (1994) Measurements of intercondylar notch by plain film radiography and magnetic resonance imaging. Am J Sports Med 22:204–210
Hoteya K, Kato Y, Motojima S, Ingham SJ, Horaguchi T, Saito A, Tokuhashi Y (2011) Association between ICN narrowing and bilateral ACL injury in athletes. Arch Ortho Trauma Surg 131:371–376
Ireland ML, Ballantyne BT, Little K, McClay IS (2001) A radiographic analysis of relationship between the size and shape of ICN and ACL injury. Knee Surg Sports Traumatol Arthrosc 9:200–205
La prade RF, Burnett QM (1994) Femoral intercondylar notch stenosis and correlation to anterior cruciate ligament injuries. Am J Sports Med 22:198–202
Lombardo S, Sethi PM, Starkey C (2005) Intercondylar notch stenosis is not a risk factor for anterior cruciate ligament tears in professional male basketball players: an 11 year prospective study. Am J Sports Med 33:29–34
Posthumus M, September AV, Keegan M, O’Cuinneagain D, Van der Merwe W, Schwellnus MP, Collins M (2009) Genetic risk factors for anterior cruciate ligament rupture: COL 1 A1 gene variant. Br J Sports Med 43:352–356
Rishiraj N, Taunton JE, Lloyd-Smith R, Woollard R, Regan W, Clement DB (2009) The potential role of prophylactic/functional knee bracing in preventing knee ligament injury. Sports Med 39:937–960
Shelbourne KD, Facibene WA, Hunt JJ (1997) Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears. Knee Surg Sports Truamatol Arthrosc 5:229–233
Souryal TO, Freeman TR (1993) Intercondylar notch size and anterior cruciate ligament injury in athletes. A prospective study. Am J Sports Med 21:535–539
Swenson TM, Harner CD (1995) Knee ligaments and meniscal injuries. Current concepts. Ortho Clin North Am 26:529–546
Uhorchak JM, Scoville CR, Williams GN, Arciero RA, St Pierre P, Taylor DC (2003) Risk factors associated with noncontact injury of the anterior cruciate ligament: a prospective 4-year evaluation of 859 West Point cadets. Am J Sports Med 31:831–842
Van Eck CF, Martins CA, Vyas SM, Celentano U, van Dijk CN, Fu FH (2010) Femoral intercondylar notch shape and dimensions in ACL injured patients. Knee Surg Sports Traumatol Arthrosc 18:1257–1262
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Al-Saeed, O., Brown, M., Athyal, R. et al. Association of femoral intercondylar notch morphology, width index and the risk of anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 21, 678–682 (2013). https://doi.org/10.1007/s00167-012-2038-y
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DOI: https://doi.org/10.1007/s00167-012-2038-y