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Association between intercondylar notch narrowing and bilateral anterior cruciate ligament injuries in athletes

Archives of Orthopaedic and Trauma Surgery volume 131, pages 371–376 (2011)Cite this article

Abstract

Background

Intercondylar notch narrowing is a risk factor for anterior cruciate ligament (ACL) injuries, but it is unclear whether a narrow intercondylar notch correlates with bilateral ACL injuries.

Purpose

To determine whether a narrow intercondylar notch is associated with bilateral ACL knee injuries in athletes, using magnetic resonance imaging (MRI) and radiography to investigate the notch size.

Study design

A retrospective case–control study.

Methods

This was a comparative cohort study on 50 subjects of which 25 patients with sport trauma-associated bilateral ACL injuries, 30 with unilateral ACL injuries, and 20 healthy subjects. The notch width index (NWI) was measured as the ratio of the width of the intercondylar notch to the femoral condylar width on radiography and the MRI slice containing the region near the ACL attachment site on the femoral side (NWI-A) and on the following posterior slice (NWI-P).

Results

The mean NWI values on radiography were 0.257 (SD 0.040), 0.332 (SD 0.036), and 0.341 (SD 0.027) in the bilateral, unilateral, and control groups, respectively, with significant differences between the bilateral and unilateral groups and the bilateral and healthy groups. On MRI, the mean NWI-A values were 0.236 (SD 0.025), 0.243 (SD 0.048), and 0.266 (SD 0.030), respectively, with a significant difference between the bilateral and healthy groups. The mean NWI-P values were 0.239 (SD 0.021), 0.258 (SD 0.038), and 0.273 (SD 0.033), respectively, with significant differences between the bilateral and unilateral groups and the unilateral and healthy groups. A cutoff value of 0.25 for NWI-P gave an odds ratio of 22.667 for the risk of developing bilateral ACL knee injuries.

Conclusions

The intercondylar notch was significantly narrower in subjects with bilateral ACL injuries than in healthy subjects. NWI measurement using coronal MRI is useful for judging intercondylar notch narrowing. The risk for ACL injuries is very high when NWI is ≤0.25. Preventive measures for the unaffected knee are required for patients with a narrow intercondylar notch.

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References

  1. Johnson RJ (1983) The anterior cruciate ligament problem. Clin Orthop Relat Res 172:14–18

    Google Scholar 

  2. Ejerhed L, Kartus J, Sernert N, Kohler K, Karlsson J (2003) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med 31:19–25

    PubMed  Google Scholar 

  3. Fu FH, Shen W, Starman JS, Okeke N, Irrgang JJ (2008) Primary anatomic double-bundle anterior cruciate ligament reconstruction: a preliminary 2-year prospective study. Am J Sports Med 36:1263–1274

    Article  PubMed  Google Scholar 

  4. Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025

    Article  PubMed  Google Scholar 

  5. Palmer I (2007) On the injuries to the ligaments of the knee joint: a clinical study. 1938. Clin Orthop Relat Res 454:17–22 discussion 14

    Article  PubMed  Google Scholar 

  6. 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 7:209–214

    CAS  Article  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

    Google Scholar 

  8. 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

    CAS  Article  PubMed  Google Scholar 

  9. Simon RA, Everhart JS, Nagaraja HN, Chaudhari AM (2010) A case–control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech 43:1702–1707

    CAS  Article  PubMed  Google Scholar 

  10. Souryal TO, Freeman TR (1993) Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med 21:535–539

    CAS  Article  PubMed  Google Scholar 

  11. Stein V, Li L, Guermazi A, Zhang Y, Kent Kwoh C, Eaton CB, Hunter DJ (2010) The relation of femoral notch stenosis to ACL tears in persons with knee osteoarthritis. Osteoarthritis Cartilage 18:192–199

    CAS  Article  PubMed  Google Scholar 

  12. Teitz CC, Lind BK, Sacks BM (1997) Symmetry of the femoral notch width index. Am J Sports Med 25:687–690

    CAS  Article  PubMed  Google Scholar 

  13. 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

    CAS  Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    CAS  Article  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  17. Holmblad EC (1937) Postero-anterior X-ray view of the knee in flexion. J Am Med Assoc 109:1196–1197

    Google Scholar 

  18. Steckel H, Vadala G, Davis D, Fu FH (2006) 2D and 3D 3-tesla magnetic resonance imaging of the double bundle structure in anterior cruciate ligament anatomy. Knee Surg Sports Traumatol Arthrosc 14:1151–1158

    Article  PubMed  Google Scholar 

  19. Steckel H, Vadala G, Davis D, Musahl V, Fu FH (2007) 3-T MR imaging of partial ACL tears: a cadaver study. Knee Surg Sports Traumatol Arthrosc 15:1066–1071

    Article  PubMed  Google Scholar 

  20. Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574

    Article  PubMed  Google Scholar 

  21. Pujol N, Blanchi MP, Chambat P (2007) The incidence of anterior cruciate ligament injuries among competitive Alpine skiers: a 25-year investigation. Am J Sports Med 35:1070–1074

    Article  PubMed  Google Scholar 

  22. Salmon L, Russell V, Musgrove T, Pinczewski L, Refshauge K (2005) Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy 21:948–957

    Article  PubMed  Google Scholar 

  23. Wright RW, Dunn WR, Amendola A, Andrish JT, Bergfeld J, Kaeding CC, Marx RG, McCarty EC, Parker RD, Wolcott M, Wolf BR, Spindler KP (2007) Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a prospective MOON cohort study. Am J Sports Med 35:1131–1134

    Article  PubMed  Google Scholar 

  24. Eiling E, Bryant AL, Petersen W, Murphy A, Hohmann E (2007) Effects of menstrual-cycle hormone fluctuations on musculotendinous stiffness and knee joint laxity. Knee Surg Sports Traumatol Arthrosc 15:126–132

    CAS  Article  PubMed  Google Scholar 

  25. Hewett TE, Zazulak BT, Myer GD (2007) Effects of the menstrual cycle on anterior cruciate ligament injury risk: a systematic review. Am J Sports Med 35:659–668

    Article  PubMed  Google Scholar 

  26. Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L (2008) Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 42:394–412

    CAS  Article  PubMed  Google Scholar 

  27. Agel J, Arendt EA, Bershadsky B (2005) Anterior cruciate ligament injury in national collegiate athletic association basketball and soccer: a 13-year review. Am J Sports Med 33:524–530

    Article  PubMed  Google Scholar 

  28. 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 29:58–66

    CAS  PubMed  Google Scholar 

  29. Mountcastle SB, Posner M, Kragh JF Jr, Taylor DC (2007) Gender differences in anterior cruciate ligament injury vary with activity: epidemiology of anterior cruciate ligament injuries in a young, athletic population. Am J Sports Med 35:1635–1642

    Article  PubMed  Google Scholar 

  30. Sward P, Kostogiannis I, Roos H (2010) Risk factors for a contralateral anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 18:277–291

    Article  PubMed  Google Scholar 

  31. Iriuchishima T, Tajima G, Ingham SJ, Shen W, Smolinski P, Fu FH (2010) Impingement pressure in the anatomical and nonanatomical anterior cruciate ligament reconstruction: a cadaver study. Am J Sports Med 38:1611–1617

    Article  PubMed  Google Scholar 

  32. Kato Y, Hoshino Y, Ingham SJ, Fu FH (2010) Anatomic double-bundle anterior cruciate ligament reconstruction. J Orthop Sci 15:269–276

    Article  PubMed  Google Scholar 

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Conflict of interest

We have no financial relationship with the organization that sponsored the research. The authors have no conflict of interest.

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Affiliations

  1. Department of Orthopaedic Surgery, Nihon University, School of medicine, 30-1, Ohyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan

    Koh Hoteya, Yuki Kato, Sayaka Motojima, Takashi Horaguchi, Akiyoshi Saito & Yasuaki Tokuhashi

  2. Department of Orthopaedic Surgery, Nihon University, Nerima Hikarigaoka Hospital, 2-11-1, Hikarigaoka, Nerima-ku, Tokyo, 179-0072, Japan

    Yuki Kato

  3. Department of Orthopaedic Surgery, Honjo General Hospital, Saitama, Japan

    Koh Hoteya

  4. Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil

    Sheila J. Ingham

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  1. Koh Hoteya
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  2. Yuki Kato
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  3. Sayaka Motojima
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  5. Takashi Horaguchi
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Correspondence to Yuki Kato.

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Hoteya, K., Kato, Y., Motojima, S. et al. Association between intercondylar notch narrowing and bilateral anterior cruciate ligament injuries in athletes. Arch Orthop Trauma Surg 131, 371–376 (2011). https://doi.org/10.1007/s00402-010-1254-5

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  • DOI: https://doi.org/10.1007/s00402-010-1254-5

Keywords

  • Anterior cruciate ligament
  • Bilateral knee injuries
  • Notch width index
  • Athletes
  • Intercondylar notch