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Diagnostic value of the lateral femoral notch sign and kissing contusion in patients with anterior cruciate ligament injuries: a case–control study

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The lateral femoral notch sign (LFNS) and the kissing contusion (KC) are two indirect signs of anterior cruciate ligament (ACL) injuries. They can be used to diagnose ACL injuries.

Materials and methods

A total of 1000 patients were enrolled in this study, including 500 patients with ACL injuries who assigned to experimental group and 500 patients with meniscal tear (MT) who allocated to control group. All the patients underwent magnetic resonance imaging (MRI) preoperatively, and the diagnosis was confirmed with the aid of arthroscopy. The depth of LFNS and the presence of KC were determined on MRI findings. The relationship and characteristics between these two indicators was explored.

Results

The notch depth of lateral femoral condyle in the experimental group (0.99 ± 0.56 mm) was significantly greater than that in the control group (0.49 ± 0.28 mm) (P < 0.05). The positive rate of KC in the experimental group (183/500) was markedly higher than that in the control group (3/500) (P < 0.05). The values of notch depth in patients who had ACL rupture concomitant lateral MT injuries and medial collateral ligament (MCL) injuries were 1.12 ± 0.64 and 1.23 ± 0.74 mm, respectively, which were significantly higher than those in patients with only ACL injury (0.89 ± 0.49 mm) (P < 0.05). It also was revealed that when the optimal cut-off point of LFNS was 0.72 mm (area under the curve (AUC) = 81%), the values of specificity and sensitivity were 67% and 84%, respectively. For KC, the corresponding values were 36.6% and 99.4%, respectively. The diagnostic outcome of LFNS was not in agreement with that of KC, as there was a poor coincidence according to the Kappa coefficient (Kappa = 0.155 < 0.4, P = 0.035).

Conclusion

The LFNS and KC have strong clinical significance in the diagnosis of ACL injuries. A deeper notch often indicates a more complex knee injury. Notch depth equal to 0.72 mm can be basically considered as the optimal cut-off point for LFNS in statistics.

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Availability of data and material

The datasets used or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Thank Professor Zhuozhao Zheng and my girlfriend Danyu Chen for their advice and help on this study.

Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. School of Clinical Medicine, Tsinghua University, Beijing, China

    Heng Gong & Lianxu Chen

  2. Peking University Third Hospital, Beijing, China

    Haijun Wang

  3. Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China

    Heng Gong, Xiaofei Zhang, Ligong Fu & Lianxu Chen

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  1. Heng Gong
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  2. Haijun Wang
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  4. Ligong Fu
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Contributions

HG contributed to the article writing and data collection. HW contributed to some imaging data and surgery. XZ contributed to part of the statistics of the article. LF directed the writing of the article. LXC designed the study and was responsible for the paper.

Corresponding author

Correspondence to Lianxu Chen.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was approved by the ethical committee of Beijing Tsinghua Changgung Hospital (No. 21033-6-01).

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Our study only involves the image information of patients. It is not necessary to obtain consent.

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Gong, H., Wang, H., Zhang, X. et al. Diagnostic value of the lateral femoral notch sign and kissing contusion in patients with anterior cruciate ligament injuries: a case–control study. Arch Orthop Trauma Surg 143, 927–934 (2023). https://doi.org/10.1007/s00402-022-04366-9

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  • DOI: https://doi.org/10.1007/s00402-022-04366-9

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