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The relationship of distal femur and proximal tibia morphology with anterior cruciate ligament injuries

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Abstract

Purpose

The study aims to determine the correlations between the anatomical structures of the distal femur and proximal tibia associated with the anterior cruciate ligament (ACL).

Methods

Bilateral extremities of 293 patients [143 ACL-ruptured, 150 ACL-intact] (all male) were included in the study. Femoral bi-condylar width (BCW), intercondylar notch width (NW) in the distal femur, proximal tibia width (TW), and tibial eminence width (EW) parameters were measured in the proximal tibia. Indexes are calculated as intercondylar notch width index (NWI) = NW/BCW, tibial eminence width index (EWI) = EW/TW.

Results

BCW, NW, TW, and EW measurements were lower in the ACL-ruptured group, but the difference was statistically significant only in the NW (p = 0.009) and TW (p = 0.005) measurements. There was no difference between groups in the NWI. The EWI parameters were calculated higher in the ACL-ruptured group, and the difference was statistically significant (p = 0.02). In both groups, there were very strong correlations between BCW and TW (ACL-ruptured r = 0.820, ACL-intact r = 0.877) and between NW and NWI (ACL-ruptured r = 0.862, ACL-intact r = 0.852), also EW and EWI in ACL-intact group (r = 0.947).

Conclusions

The NW and TW measurements may give an idea about injury risk or prevention in morphological measurements. Correlations also show that the femur and tibia should consider together for ACL injuries.

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Availability of data and materials

The data that support the findings of this study are available on request from the corresponding author, KÇ. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

References

  1. Anderson AF, Lipscomb AB, Liudahl KJ, Addlestone RB (1987) Analysis of the intercondylar notch by computed tomography. Am J Sports Med 15:547–552. https://doi.org/10.1177/036354658701500605

    Article  CAS  PubMed  Google Scholar 

  2. Anderson AF, Dome DC, Gautam S, Awh MH, Rennirt GW (2001) Correlation of anthropometric measurements, strength, anterior cruciate ligament size, and intercondylar notch characteristics to sex differences in anterior cruciate ligament tear rates. Am J Sports Med 29(1):58–66. https://doi.org/10.1177/03635465010290011501

    Article  CAS  PubMed  Google Scholar 

  3. Anderson AF, Anderson CN, Gorman TM, Cross MB, Spindler KP (2007) Radiographic measurements of the intercondylar notch: are they accurate? Arthrosc 23:261–268. https://doi.org/10.1016/j.arthro.2006.11.003

    Article  Google Scholar 

  4. Cay N, Acar HI, Dogan M et al (2022) Radiological evaluation of femoral intercondylar notch and tibial intercondylar eminence morphometries in anterior cruciate ligament pathologies using magnetic resonance imaging. JOIO 56:327–337. https://doi.org/10.1007/s43465-021-00490-7

    Article  Google Scholar 

  5. Davis TJ, Shelbourne KD, Klootwyk TE (1999) Correlation of the intercondylar notch width of the femur to the width of the anterior and posterior cruciate ligaments. Knee Surg Sports Traumatol Arthrosc 7(4):209–214. https://doi.org/10.1007/s001670050150

    Article  CAS  PubMed  Google Scholar 

  6. Duparc F, Thomine JM, Simonet J, Biga N (2014) Femoral and tibial bone torsions associated with medial femoro-tibial osteoarthritis Index of cumulative torsions. OTSR 100(1):69–74. https://doi.org/10.1016/j.otsr.2013.12.014

    Article  CAS  PubMed  Google Scholar 

  7. Good L, Odensten M, Gillquist J (1991) Intercondylar notch measurements with special reference to anterior cruciate ligament surgery. Clin Orthop Relat Res 263:185–189

    Article  Google Scholar 

  8. Hashemi J, Chandrashekar N, Gill B, Beynnon BD, Slauterbeck JR, JrRC S, Mansouri H, Dabezies E (2008) The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Jt Surg 90(12):2724–2734. https://doi.org/10.2106/JBJS.G.01358

    Article  Google Scholar 

  9. Herzog RJ, Silliman JF, Hutton K, Rodkey WG, Steadman JR (1994) Measurements of the intercondylar notch by plain film radiography and magnetic resonance imaging. Am J Sports Med 22:204–210

    Article  CAS  PubMed  Google Scholar 

  10. Ireland ML, Ballantyne BT, Little K et al (2001) A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 9:200–205. https://doi.org/10.1007/s001670100197

    Article  CAS  PubMed  Google Scholar 

  11. Iriuchishima T, Goto B, Fu FH (2020) The occurrence of ACL injury influenced by the variance in width between the tibial spine and the femoral intercondylar notch. Knee Surg Sports Traumatol Arthrosc 28:3625–3630. https://doi.org/10.1007/s00167-020-05965-y

    Article  PubMed  Google Scholar 

  12. Li Y, Chou K, Zhu W, Xiong J, Yu M (2020) Enlarged tibial eminence may be a protective factor of anterior cruciate ligament. Med Hypotheses 144:110230. https://doi.org/10.1016/j.mehy.2020.110230

    Article  PubMed  Google Scholar 

  13. 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(1):29–34. https://doi.org/10.1177/0363546504266482

    Article  PubMed  Google Scholar 

  14. Lund-Hanssen H, Gannon J, Engebretsen L, Holen KJ, Anda S, Vatten L (1994) Intercondylar notch width and the risk for anterior cruciate ligament rupture: A case-control study in 46 female handball players. Acta Orthop Scand 65:529–532. https://doi.org/10.3109/17453679409000907

    Article  CAS  PubMed  Google Scholar 

  15. Muneta T, Takakuda K, Yamamoto H (1997) Intercondylar notch width and its relation to the configuration and cross-sectional area of the anterior cruciate ligament: a cadaveric knee study. Am J Sports Med 25:69–72. https://doi.org/10.1177/036354659702500113

    Article  CAS  PubMed  Google Scholar 

  16. Schickendantz MS, Weiker GG (1993) The predictive value of radiographs in the evaluation of unilateral and bilateral anterior cruciate ligament injuries. Am J Sports Med 21:110–113. https://doi.org/10.1177/036354659302100118

    Article  CAS  PubMed  Google Scholar 

  17. Shelbourne KD, Davis TJ, Klootwyk TE (1998) The relationship between intercondylar notch width of the femur and the incidence of anterior cruciate ligament tears. A prospective study. Am J Sports Med 26:402–408. https://doi.org/10.1177/03635465980260031001

    Article  CAS  PubMed  Google Scholar 

  18. Standring S, Borley NR, Gray H (2008) Gray's anatomy: the anatomical basis of clinical practice: 40th ed. Churchill Livingstone/Elsevier: 1362, 1397, 1401

  19. Stijak L, Herzog RF, Schai P (2008) Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study. Knee Surg Sports Traumatol Arthrosc 16(2):112–117. https://doi.org/10.1007/s00167-007-0438-1

    Article  PubMed  Google Scholar 

  20. Souryal TO, Moore HA, Evans JP (1988) Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis. Am J Sports Med 16:449–454. https://doi.org/10.1177/036354658801600504

    Article  CAS  PubMed  Google Scholar 

  21. Souryal TO, Freeman TR (1993) Intercondylar notch size and anterior cruciate ligament injuries in athletes A prospective study [published correction appears. Am J Sports Med 21:535–539. https://doi.org/10.1177/036354659302100410

    Article  CAS  PubMed  Google Scholar 

  22. 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 four-year evaluation of 859 West Point cadets. Am J Sports Med 3:831–842. https://doi.org/10.1177/03635465030310061801

    Article  Google Scholar 

  23. Wada M, Tatsuo H, Baba H, Asamoto K, Nojyo Y (1999) Femoral intercondylar notch measurements in osteoarthritic knees. Rheumatology (Oxford) 38(6):554–558. https://doi.org/10.1093/rheumatology/38.6.554

    Article  CAS  PubMed  Google Scholar 

  24. Xiao WF, Yang T, Cui Y, Zeng C, Wu S, Wang YL, Lei GH (2016) Risk factors for noncontact anterior cruciate ligament injury: Analysis of parameters in proximal tibia using anteroposterior radiography. J Int Med Res 44:157–163. https://doi.org/10.1177/0300060515604082

    Article  PubMed  Google Scholar 

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Anatomy, Faculty of Medicine, Sivas Cumhuriyet University, 58140, Sivas, Turkey

    Kaan Çimen & İlhan Otağ

  2. Department of Orthopedics and Traumatology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey

    Zekeriya Oztemür

Authors
  1. Kaan Çimen
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  2. İlhan Otağ
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Contributions

KÇ Study design, data collection and management, manuscript drafting and editing, figure design. İO Study design, data management, manuscript editing, table design. ZO Study design, physical examinations, surgical procedures, patient selection, manuscript editing. All authors approved the final manuscript.

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Correspondence to Kaan Çimen.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

Ethical approval was obtained from our institution’s non-invasive clinical research ethics committee (2018–12/12). The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was not required for this type of study.

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Çimen, K., Otağ, İ. & Oztemür, Z. The relationship of distal femur and proximal tibia morphology with anterior cruciate ligament injuries. Surg Radiol Anat 45, 495–501 (2023). https://doi.org/10.1007/s00276-023-03097-9

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  • DOI: https://doi.org/10.1007/s00276-023-03097-9

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