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Hirtler L, Schreiner M, Röhrich S, Kandathil SA, Kainberger F. Morphological changes to the intercondylar space in different stages of osteoarthritis - A retrospective cross-sectional study. Ann Anat 2025; 259:152388. [PMID: 39884442 DOI: 10.1016/j.aanat.2025.152388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 12/08/2024] [Accepted: 01/21/2025] [Indexed: 02/01/2025]
Abstract
BACKGROUND The intercondylar space is defined as the topographic area walled by the intercondylar notch (IN) and encasing the central ligaments of the knee joint. As the anterior cruciate ligament (ACL) is not only impinged against the roof but also against the lateral wall of the IN, information concerning changes to the IN during the progression of osteoarthritis could be potentially relevant in predicting the future risk for ACL-rupture and -degeneration and ensure preventive measures as early as possible. Therefore, the purpose of this study was to evaluate the influence of osteoarthritis on osseous notch morphology. METHODS Image data was retrieved from the Osteoarthritis Initiative. Patients were subdivided into five groups according to the severity of osteoarthritis following the Kellgren and Lawrence classification. 415 patients were selected randomly to ensure equally large groups. Osseous structures were measured in coronal and axial planes in MRI. At the level of the popliteal groove and on the level of the joint line, the width of the lateral and medial femoral condyle, the notch width (NW) as well as the total width of the distal femur were measured. The notch width index (NWI) as ratio between the NW and the total width of the distal femur was calculated. Three shapes (A-shape, Inverse-U-shape and Ω-shape) of the IN were differentiated. RESULTS The morphology of the IN is directly influenced by the development of osteoarthritis. Especially the Ω-shape is characteristic for more severe cases of osteoarthritis (p < 0.001). Measurements were also significantly influenced by the imaging plane and the level of measurements (both p < 0.001). CONCLUSIONS The results of this study reflect significant changes to the intercondylar space in increasing grades of osteoarthritis. Additionally, the recommendation on the location of measurements of the IN should be revised, as especially the measurements on the level of the joint line in coronal plane MRI are a more reliable and objective indicator for the diagnosis of IN stenosis and therefore of changes to the intercondylar space, which always influences the health of the ligaments housed. At the level of the popliteal groove a NWI< 0.25 and NW< 19 mm and at the level of the joint line a NWI< 0.17 and a NW< 14 mm should be interpreted as severe notch stenosis and a definitive risk factor for ACL rupture.
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Affiliation(s)
- Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
| | - Markus Schreiner
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Sebastian Röhrich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sam A Kandathil
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria; Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria; Teaching Center, Medical University of Vienna, Vienna, Austria
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Centner C, Fiedler C, Heitner AH, Paul J, Imhoff FB. Tibiofemoral bone configuration is not associated with hamstring muscle strength in male and female patients with ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2024; 32:2601-2609. [PMID: 38690972 DOI: 10.1002/ksa.12220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Previous evidence indicated that the tibiofemoral bone configuration might elevate the risk of an anterior cruciate ligament (ACL) injury. Furthermore, a low hamstring-to-quadriceps muscle ratio predisposes especially females to unfavourable knee kinematics. The primary objective of the present study was to investigate sex-specific associations between tibiofemoral bone geometry and isokinetic knee flexion torque in patients with primary ACL injury followed by ACL reconstruction. METHODS N = 100 patients (72 = male, 28 = female, age = 31.3 ± 10.2, body mass index = 25.3 ± 3.6) with primary ACL rupture with isokinetic knee flexion torque assessments before and 6 months after ACL reconstruction surgery were analysed. Magnetic resonance imaging scans were analysed for medial posterior tibial slope (MPTS) and lateral posterior tibial slope, notch width index (NWI) and lateral femoral condyle index (LFCI). Additionally, isokinetic knee flexion torque (60°/s) and hamstring-quadriceps ratios were evaluated. Subsequently, functional parameters were correlated with imaging data for gender subgroups. RESULTS The findings showed that presurgical isokinetic knee flexion torque was not associated with any marker of femoral or tibial bone geometry. Further, while significant differences were observed between female (0.883 ± 0.31 Nm/kg) and male (1.18 ± 0.35 Nm/kg) patients regarding preoperative normalized knee flexion torque (p < 0.001), no significant sex differences were found for percentage increases in normalized knee flexion torque from presurgery to postsurgery. Generally, female patients demonstrated significantly higher MPTS magnitudes (p < 0.05) and lower LFCI values (p < 0.05) compared to men. CONCLUSION The present results demonstrated no association between tibial or femoral bone geometry and muscle strength of the hamstrings in patients with ACL reconstruction, indicating an important mismatch of muscular compensation to deviations in bone geometry. There were no sex-specific differences in tibiofemoral bone parameters. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | | | | | - Florian B Imhoff
- Rennbahnklinik, Muttenz, Switzerland
- Orthopädie und Traumatologie, Universitätsklinik Basel, Basel-Stadt, Switzerland
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Gan X, Chen X, Zeng Y, Li M, Nie M, Kang H. Comparative morphology of the cruciate ligaments: A radiological study. Open Med (Wars) 2024; 19:20241005. [PMID: 39091609 PMCID: PMC11292788 DOI: 10.1515/med-2024-1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024] Open
Abstract
Background The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are important structures to maintain knee stability. The present study aimed to further enrich understandings of the morphology of the cruciate ligaments and explore the relationship between the diameter of ACL and PCL. Method This study collected valid MRI samples of 50 male and 50 female normal right knee joints and measured the diameter of each point of the ACL and PCL through the 3D Slicer. Results The diameter of the ACL in the sagittal MRI of the normal right knee joint was significantly different from the diameter of each point of the PCL. The average diameter of each point of the ACL was larger than the diameter of the corresponding point of the PCL. Males and females had statistical differences in their PCL origin point, PCL midpoint, ACL origin point, ACL midpoint, and ACL insertion point diameters under sagittal MRI examination. The average diameter of males was greater than the average diameter of females at the above corresponding sites. In sagittal MRI scans of the normal right knee joint, we observed that only the origin point of the PCL exhibited a moderate correlation with the midpoint and insertion point of the ACL in terms of their respective diameters. Conclusion The correlation between diameters of normal ACL and PCL in knee joint MRI was moderate and may help clinicians determine appropriate graft for cruciate ligament reconstruction surgery quickly for severe cruciate ligament injuries.
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Affiliation(s)
- Xin Gan
- Department of Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
- National Medical Center for Major Public Health Events, Wuhan, P. R. China
| | - Xin Chen
- Department of Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
- National Medical Center for Major Public Health Events, Wuhan, P. R. China
| | - Yunqian Zeng
- Department of Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
- National Medical Center for Major Public Health Events, Wuhan, P. R. China
| | - Mengwei Li
- Department of Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
- National Medical Center for Major Public Health Events, Wuhan, P. R. China
| | - Mingbo Nie
- Department of Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
- National Medical Center for Major Public Health Events, Wuhan, P. R. China
| | - Hao Kang
- Department of Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
- National Medical Center for Major Public Health Events, Wuhan, P. R. China
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Gao H, Hu H, Sheng D, Sun L, Chen J, Chen T, Chen S. Risk Factors for Ipsilateral Versus Contralateral Reinjury After ACL Reconstruction in Athletes: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231214298. [PMID: 38145217 PMCID: PMC10748928 DOI: 10.1177/23259671231214298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) reinjury after ACL reconstruction (ACLR) can occur on the ipsilateral or contralateral side. Limited evidence exists regarding the difference between the incidence of reinjury to either knee, which is important in developing interventions to prevent ACL reinjury. Purpose To compare the reinjury rate of the ACL on the ipsilateral side versus the contralateral side in athletes after ACLR and investigate the risk factors that may cause different reinjury rates between the sides. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that involved ACL reinjury in athletes after ACLR were reviewed. Considering several risk factors, including age and sex, a comparison of ACL reinjury incidence on the ipsilateral and contralateral sides was performed using a meta-analysis. Results Of the 17 selected studies, 3 were found to be at high risk of bias, and thus, 14 (n = 3424 participants) studies were included in the meta-analysis. In this athletic population, the contralateral ACL had a significantly higher rupture rate than the ipsilateral graft (risk ratio [RR], 1.41; P < .0001). Female athletes were found to have a greater risk of ACL reinjury on the contralateral versus the ipsilateral side (RR, 1.65; P = .0005), but different results were found in male athletes. (RR, 0.81; P = .21). There was no statistical difference in the incidence rate of ACL reinjury to either side in adolescent athletes (RR, 1.15; P = .28). Conclusion The contralateral ACL was more vulnerable to reinjury than the ipsilateral side in athletes after ACLR. Female athletes were more likely to reinjure their contralateral native ACL, while the same trend was not found in their male counterparts. The reinjury rate was comparable in both knees in adolescent athletes.
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Affiliation(s)
- Han Gao
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Haichen Hu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- H.G., H.H., and D.S. contributed equally to this study
| | - Luyi Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Altinayak H, Karatekin YS. Increased Medial Femoral Condyle Angle and Narrow Intercondylar Notch Are Associated With Medial Meniscus Posterior Root Tear. Arthroscopy 2023; 39:2154-2163. [PMID: 36868529 DOI: 10.1016/j.arthro.2023.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To investigate the correlation between nontraumatic medial meniscus posterior root tear (MMPRT) and bone morphology of the knee with a particular emphasis on MMPR impingement. METHODS Magnetic resonance imaging (MRI) findings were examined between January 2018 and December 2020. MRI findings of patients with traumatic MMPRT, Kellgren Lawrence stage 3-4 arthropathy on radiographs, single- or multiple-ligament injuries and/or those who underwent treatment for these diseases, and surgery in and around the knee were excluded from the study. MRI measurements included medial femoral condylar angle (MFCA), intercondylar distance (ICD), and intercondylar notch width (ICNW), distal/posterior medial femoral condylar offset ratio, notch shape, medial tibial slope (MTS) angle, and medial proximal tibial angle (MPTA) measurements and spur presence and were compared between groups. All measurements were performed by two board-certified orthopedic surgeons on a best agreement basis. RESULTS MRI examinations of patients aged 40-60 were analyzed. MRI findings were divided into two groups: the study group of MRI findings of patients with MMPRT (n = 100) and the control group of MRI findings of patients without MMPRT (n = 100). MFCA was found to be significantly higher in the study group (mean: 46.5 ± 3.58) than in the control group (mean: 40.04 ± 4.61) (P < .001). In the study group, the ICD (study group mean: 76.26 ± 4.89; control group mean: 78.18 ± 6.1) was significantly narrower (P = .018), and the ICNW (study group mean: 17.19 ± 2.23; control group mean: 20.48 ± 2.13) was significantly shorter (P < .001). The ICNW/ICD ratio was significantly lower in patients in the study group (0.22 ± 0.02) than in the control group (0.25 ± 0.02) (P < .001). Bone spurs were present in 84% of the study group and only in 28% of those in the control group. In the study group, the most common notch type was A-type with 78%, while the least common was the U-type notch with 10%. However, in the control group, the most common notch type was A-type with 43%, and the least common was the W-type notch with 22%. The distal/posterior medial femoral condylar offset ratio was statistically lower in the study group (0.72 ± 0.07) than in the control group 0.78 ± 0.07) (P < .001). No significant intergroup differences were found in MTS (study group mean: 7.51 ±2.59; control group mean: 7.83 ± 2.57) (P = .390) and MPTA (study group mean: 86.92 ±2.15; control group mean: 87.48 ±1.8) measurements (P = .67). CONCLUSIONS Increased medial femoral condylar angle, low distal/posterior femoral offset ratio, narrow intercondylar distance and intercondylar notch width, A-type notch shape, and spur presence are associated with MMPRT. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Harun Altinayak
- Health Sciences University Samsun Training and Research Hospital, Department of Orthopaedics and Traumatology, Samsun, Turkey.
| | - Yavuz Selim Karatekin
- Health Sciences University Samsun Training and Research Hospital, Department of Orthopaedics and Traumatology, Samsun, Turkey
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Pradhan P, Kaushal SG, Kocher MS, Kiapour AM. Development of Anatomic Risk Factors for ACL Injuries: A Comparison Between ACL-Injured Knees and Matched Controls. Am J Sports Med 2023; 51:2267-2274. [PMID: 37310177 DOI: 10.1177/03635465231177465] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Several tibiofemoral anatomic features have been repeatedly associated with increased anterior cruciate ligament (ACL) injury risk. Previous studies have highlighted age and sex differences among these anatomic risk factors, but little is known about the normal and pathologic development of these differences during skeletal maturation. PURPOSE To investigate differences in anatomic risk factors at various stages of skeletal maturation between ACL-injured knees and matched controls. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS After institutional review board approval, magnetic resonance imaging scans from 213 unique ACL-injured knees (age, 7-18 years, 48% female) and 239 unique asymptomatic ACL-intact knees (age, 7-18 years, 50% female) were used to measure femoral notch width, posterior slope of the lateral and medial tibial plateau, medial and lateral tibial spinal height (MTSH, LTSH), medial tibial depth, and posterior lateral meniscus-bone angle. Linear regression was performed to assess change in quantified anatomic indices with age for male and female patients in the ACL-injured cohort. Two-way analysis of variance with Holm-Sidak post hoc testing was performed to compare anatomic indices between ACL-injured knees and ACL-intact controls in each age group. RESULTS In the ACL-injured cohort, notch width, notch width index and medial tibial depth increased with age (R2 > 0.1; P < .001) in both sexes. MTSH and LTSH increased with age only in boys (R2≥ 0.09; P≤ .001), whereas meniscus-bone angle decreased with age only in girls (R2 = 0.13; P < .001). There were no other age differences in quantified anatomic indices. Patients with ACL injury consistently had a significantly higher lateral tibial slope (P < .01) and smaller LTSH (P < .001) as compared with ACL-intact controls across all age groups and sexes. When compared with age- and sex-matched ACL-intact controls, ACL-injured knees had a smaller notch width (boys, 7-18 years; girls, 7-14 years; P < .05), larger medial tibial slope (boys and girls, 15-18 years; P < .01), smaller MTSH (boys, 7-14 years; girls, 11-14 years; P < .05), and larger meniscus-bone angle (girls, 7-10 years; P = .050). CONCLUSION The consistent morphologic differences throughout skeletal growth and maturation suggest a developmental role in high-risk knee morphology. The observed high-risk knee morphology at an earlier age preliminarily suggests the potential of knee anatomy measurements in identifying those with a predisposition toward ACL injury.
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Affiliation(s)
- Pratik Pradhan
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shankar G Kaushal
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mininder S Kocher
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ata M Kiapour
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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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 2023; 45:495-501. [PMID: 36752835 DOI: 10.1007/s00276-023-03097-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
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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Affiliation(s)
- Kaan Çimen
- Department of Anatomy, Faculty of Medicine, Sivas Cumhuriyet University, 58140, Sivas, Turkey.
| | - İlhan Otağ
- Department of Anatomy, Faculty of Medicine, Sivas Cumhuriyet University, 58140, Sivas, Turkey
| | - Zekeriya Oztemür
- Department of Orthopedics and Traumatology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
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Hao K, Niu Y, Kong L, Wang F. The patient with patellar instability has a stenotic intercondylar notch and a thin anterior cruciate ligament: a retrospective comparative study. J Orthop Surg Res 2023; 18:144. [PMID: 36849936 PMCID: PMC9972627 DOI: 10.1186/s13018-023-03632-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/22/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Patellar instability (PI) usually combines with morphological abnormalities of femoral condyles that may affect the morphology of the intercondylar notch and anterior cruciate ligament (ACL), which are important in individualized ACL reconstruction. This study aimed to investigate the morphological characteristics of the intercondylar notch and ACL in patients with PI. METHODS 80 patients with PI and 160 age- and gender-matched controls from January 2014 to June 2022 were studied. Morphological measurements of the femoral condyles included intercondylar notch height, notch width, medial condylar width, lateral condylar width, bicondylar width, notch width index, notch angle, lateral femoral condyle ratio (LFCR), condyle flexion angle, and posterior tibial slope. Morphological measurements of the ACL included ACL length, inclination angle, and ACL size. The measurements were compared between PI and control groups, and between males and females in PI group. The independent samples t-test was performed to examine differences in continuous variables. The chi-square test was used for comparing categorical variables. RESULTS The intercondylar notch width, bicondylar width, notch width index, and notch angle were significantly smaller, while the LFCR was significantly larger in PI group than those of control group (p < 0.05). The ACL thickness (0.70 ± 0.16 cm vs 0.80 ± 0.21 cm, p = 0.023) and width (0.54 ± 0.14 cm vs 0.60 ± 0.13 cm, p = 0.029) were significantly smaller in PI group. The notch width was significantly smaller in female patients than males in PI group, but no significant difference was observed in the notch width index and notch angle (p > 0.05). No sex difference related to the morphology of the ACL was found. CONCLUSIONS The patient with PI had a stenotic intercondylar notch and a thin ACL. No significant sex difference in the intercondylar notch stenosis and ACL size was observed. The morphology of the intercondylar notch and ACL should be taken into consideration when planning individualized ACL reconstruction in the presence of PI.
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Affiliation(s)
- Kuo Hao
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Yingzhen Niu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Lingce Kong
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051 Hebei China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Posterior Cruciate Ligament and Patellar Tendon Can Predict Anterior Cruciate Ligament Size for Planning During ACL Reconstruction in Pediatric Patients. Arthrosc Sports Med Rehabil 2022; 5:e109-e117. [PMID: 36866304 PMCID: PMC9971886 DOI: 10.1016/j.asmr.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To establish correlations between the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and patellar tendon in normal pediatric knees to inform surgical planning for ACL reconstruction graft size. Methods Magnetic resonance imaging scans of patients ages 8 to 18 years were assessed. Measurements included ACL and PCL length, thickness, and width, and ACL footprint thickness and width at the tibial insertion. Interrater reliability was assessed with a random set of 25 patients. Pearson correlation coefficients were used to assess the correlation between ACL, PCL, and patellar tendon measurements. Linear regression models were used to test whether the relationships differed by sex or age. Results Magnetic resonance imaging scans of 540 patients were assessed. Interrater reliability was high for all measurements except PCL thickness at midsubstance. Sample equations for estimating ACL size are as follows: ACL length = 22.61 + 1.55∗PCL origin width (R2 = 0.46; 8- to 11-year-old male patients), ACL length = 12.37 + 0.58∗PCL length + 2.29∗PCL origin thickness - 0.90∗PCL insertion width (R2 = 0.68; 8- to 11-year-old female patients), ACL midsubstance thickness = 4.95 + 0.25∗PCL midsubstance thickness + 0.04∗PCL insertion thickness - 0.08∗PCL insertion width (R2 = 0.12; 12- to 18-year-old male patients), and ACL midsubstance width = 0.57 + 0.23∗PCL midsubstance thickness + 0.07∗PCL midsubstance width + 0.16∗PCL insertion width (R2 = 0.24; 12- to 18-year-old female patients). Conclusions We found correlations between ACL, PCL, and patellar tendon measurements that can be used to create equations that predict ACL size in various dimensions based on PCL and patellar tendon measurements. Clinical Relevance There is a lack of consensus on the ideal ACL graft diameter for pediatric ACL reconstruction. The findings from this study can assist orthopaedic surgeons to individualize ACL graft size for specific patients.
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Campón Chekroun A, Velázquez-Saornil J, Guillén Vicente I, Sánchez Milá Z, Rodríguez-Sanz D, Romero-Morales C, Fernandez-Jaén T, Garrido González JI, Sánchez-Garrido MÁ, Guillén García P. Consensus Delphi study on guidelines for the assessment of anterior cruciate ligament injuries in children. World J Orthop 2022; 13:777-790. [PMID: 36189335 PMCID: PMC9516626 DOI: 10.5312/wjo.v13.i9.777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/16/2022] [Accepted: 08/17/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Knee examination guidelines in minors are intended to aid decision-making in the management of knee instability. Clinical question: A Delphi study was conducted with a formal consensus process using a validated methodology with sufficient scientific evidence. A group consensus meeting was held to develop recommendations and practical guidelines for use in the assessment of instability injuries in children. Key findings: there is a lack of evidence to analyse anterior cruciate ligament injuries in children and their subsequent surgical management if necessary. Diagnostic guidelines and clinical assessment of the patient based on a thorough examination of the knee are performed and a guide to anterior cruciate ligament exploration in children is developed. Clinical application: In the absence of a strong evidence base, these established guidelines are intended to assist in that decision-making process to help the clinician decide on the most optimal treatment with the aim of benefiting the patient as much as possible. Following this expert consensus, surgical treatment is advised when the patient has a subjective sensation of instability accompanied by a pivot shift test ++, and may include an anterior drawer test + and a Lachman test +. If these conditions are not present, the conservative approach should be chosen, as the anatomical and functional development of children, together with a physiotherapy programme, may improve the evolution of the injury.
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Affiliation(s)
| | | | - Isabel Guillén Vicente
- Department of Orthopaedic and Trauma Surgery, Clínica Cemtro, Madrid 28035, Madrid, Spain
| | - Zacarías Sánchez Milá
- Department of Physiotherapy, Universidad Católica de Ávila, Ávila 05005, Ávila, Spain
| | - David Rodríguez-Sanz
- Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid 28040, Madrid, Spain
| | - Carlos Romero-Morales
- Department of Physical Therapy, Universidad Europea de Madrid, Madrid 28023, Madrid, Spain
| | - Tomas Fernandez-Jaén
- Department of Orthopaedic and Trauma Surgery, Clínica Cemtro, Madrid 28035, Madrid, Spain
| | | | | | - Pedro Guillén García
- Department of Orthopaedic and Trauma Surgery, Clínica Cemtro, Madrid 28035, Madrid, Spain
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11
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Barnett SC, Murray MM, Flannery SW, Menghini D, Fleming BC, Kiapour AM, Proffen B, Sant N, Portilla G, Sanborn R, Freiberger C, Henderson R, Ecklund K, Yen YM, Kramer D, Micheli L. ACL Size, but Not Signal Intensity, Is Influenced by Sex, Body Size, and Knee Anatomy. Orthop J Sports Med 2022; 9:23259671211063836. [PMID: 34988237 PMCID: PMC8721387 DOI: 10.1177/23259671211063836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Little is known about sex-based differences in anterior cruciate ligament (ACL) tissue quality in vivo or the association of ACL size (ie, volume) and tissue quality (ie, normalized signal intensity on magnetic resonance imaging [MRI]) with knee anatomy. Hypothesis: We hypothesized that (1) women have smaller ACLs and greater ACL normalized signal intensity compared with men, and (2) ACL size and normalized signal intensity are associated with age, activity levels, body mass index (BMI), bicondylar width, intercondylar notch width, and posterior slope of the lateral tibial plateau. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Knee MRI scans of 108 unique ACL-intact knees (19.7 ± 5.5 years, 62 women) were used to quantify the ACL signal intensity (normalized to cortical bone), ligament volume, mean cross-sectional area, and length. Independent t tests were used to compare the MRI-based ACL parameters between sexes. Univariate and multivariate linear regression analyses were used to investigate the associations between normalized signal intensity and size with age, activity levels, BMI, bicondylar width, notch width, and posterior slope of the lateral tibial plateau. Results: Compared with men, women had significantly smaller mean ACL volume (men vs women: 2028 ± 472 vs 1591 ± 405 mm3), cross-sectional area (49.4 ± 9.6 vs 41.5 ± 8.6 mm2), and length (40.8 ± 2.8 vs 38.1 ± 3.1 mm) (P < .001 for all), even after adjusting for BMI and bicondylar width. There was no difference in MRI signal intensity between men and women (1.15 ± 0.24 vs 1.12 ± 0.24, respectively; P = .555). BMI, bicondylar width, and intercondylar notch width were independently associated with a larger ACL (R2 > 0.16, P < .001). Younger age and steeper lateral tibial slope were independently associated with shorter ACL length (R2 > 0.03, P < .04). The combination of BMI and bicondylar width was predictive of ACL volume and mean cross-sectional area (R2 < 0.3). The combination of BMI, bicondylar width, and lateral tibial slope was predictive of ACL length (R2 = 0.39). Neither quantified patient characteristics nor anatomic variables were associated with signal intensity. Conclusion: Men had larger ACLs compared with women even after adjusting for BMI and knee size (bicondylar width). No sex difference was observed in signal intensity, suggesting no difference in tissue quality. The association of the intercondylar notch width and lateral tibial slope with ACL size suggests that the influence of these anatomic features on ACL injury risk may be partially explained by their effect on ACL size. Registration: NCT02292004 and NCT02664545 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Samuel C Barnett
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Martha M Murray
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sean W Flannery
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | | | - Danilo Menghini
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Braden C Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ata M Kiapour
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Benedikt Proffen
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Members of the BEAR Trial Team are listed in the Authors section at the end of this article.,Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas Sant
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Members of the BEAR Trial Team are listed in the Authors section at the end of this article.,Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriela Portilla
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Members of the BEAR Trial Team are listed in the Authors section at the end of this article.,Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan Sanborn
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Members of the BEAR Trial Team are listed in the Authors section at the end of this article.,Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christina Freiberger
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Members of the BEAR Trial Team are listed in the Authors section at the end of this article.,Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachael Henderson
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Members of the BEAR Trial Team are listed in the Authors section at the end of this article.,Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kirsten Ecklund
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Members of the BEAR Trial Team are listed in the Authors section at the end of this article.,Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Members of the BEAR Trial Team are listed in the Authors section at the end of this article.,Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis Kramer
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Members of the BEAR Trial Team are listed in the Authors section at the end of this article.,Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lyle Micheli
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedics, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.,Members of the BEAR Trial Team are listed in the Authors section at the end of this article.,Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Li W, Liang J, Zeng F, Lin B, Liu C, Huang S, Liu Q. Anatomic characteristics of the knee influence the risk of suffering an isolated meniscal injury and the risk factors differ between women and men. Knee Surg Sports Traumatol Arthrosc 2021; 29:3751-3762. [PMID: 33388828 DOI: 10.1007/s00167-020-06396-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyse the relationship between multiple anatomic characteristics of the knee (tibia and femur) and isolated meniscal injury in women and men. METHODS Forty-seven patients with isolated medial meniscal injuries, 62 patients with isolated lateral meniscal injuries, and 70 control subjects were included. Medial posterior tibial slope (MTS), lateral posterior tibial slope (LTS), medial tibial plateau depth (MTD), coronal tibial slope (CTS), femoral notch width (NW), femoral condylar width (FCW), intercondylar notch depth (ND), femoral notch width index (NWI), intercondylar notch shape index (NSI), and cruciate ligaments tensity (CLT) were measured from magnetic resonance images. Anatomic characteristics differing between groups were compared, and risk factors for isolated meniscal injury were identified by multivariate forward stepwise logistic regression for men and women separately. RESULTS Risk factors for an isolated medial meniscal injury were a steeper MTS and a lowered MTD in men, and a steeper MTS and an increased NWI in women. Risk factors for isolated lateral meniscal injury were a steeper LTS and an increased NW in men, and a steeper LTS and a lowered ND in women. Risk factors for both medial and lateral meniscal injuries were a higher CTS, an increased NWI, and a looser CLT in men, and a higher CTS, an increased NSI, and a looser CLT in women. CONCLUSION The anatomic characteristics of the tibial plateau, femur, and cruciate ligaments influence the risk of suffering isolated meniscal injury, and the risk factors differ between men and women. This study provides a reference for developing identification criteria for those at risk of isolated meniscal injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Wenhua Li
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Jie Liang
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Fei Zeng
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Bomiao Lin
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Chenglong Liu
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China.
| | - Shijia Huang
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Qiaolan Liu
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
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13
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Hirtler L, Kainberger F, Röhrich S. The intercondylar fossa-A narrative review. Clin Anat 2021; 35:2-14. [PMID: 34374453 PMCID: PMC9291140 DOI: 10.1002/ca.23773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/22/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022]
Abstract
The intercondylar fossa (“intercondylar notch,” IN) is a groove at the distal end of the femur, housing important stabilizing structures: cruciate ligaments and meniscofemoral ligaments. As the risk for injury to these structures correlates with changes to the IN, exact knowledge of its morphology, possible physiological and pathological changes and different approaches for evaluating it are important. The divergent ways of assessing the IN and the corresponding measurement methods have led to various descriptions of its possible shapes. Ridges at the medial and lateral wall are considered clinically important because they can help with orientation during arthroscopy, whereas ridges at the osteochondral border could affect the risk of ligament injury. Changes related to aging and sex differences have been documented, further emphasizing the importance of individual assessment of the knee joint. Overall, it is of the utmost importance to remember the interactions between the osseous housing and the structures within.
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Affiliation(s)
- Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Radiology and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastian Röhrich
- Department of Radiology and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
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14
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Yellin JL, Parisien RL, Talathi NS, Farooqi AS, Kocher MS, Ganley TJ. Narrow Notch Width is a Risk Factor for Anterior Cruciate Ligament Injury in the Pediatric Population: A Multicenter Study. Arthrosc Sports Med Rehabil 2021; 3:e823-e828. [PMID: 34195650 PMCID: PMC8220619 DOI: 10.1016/j.asmr.2021.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The purposes of this study were to evaluate the notch width index (NWI) as a risk factor for anterior cruciate ligament (ACL) rupture in the pediatric and adolescent patient population via multicenter analysis and to detect any differences in the NWI among cohorts having sustained either a unilateral or bilateral ACL rupture. Methods A consecutive series of patients ≤19 years old was enrolled from January 1999 through July 2010 at 2 academic pediatric orthopaedic tertiary-care hospitals. Demographic and anatomic morphology data were collected for 3 cohorts: unilateral ACL ruptures, bilateral ACL ruptures, and a control group. A single blinded reviewer determined notch width measurements via T2 coronal magnetic resonance imaging sequences in a standardized manner, using a previously described technique. Results Of the 68 patients included for analysis, 22 sustained unilateral ACL rupture, 23 sustained bilateral ruptures, and 23 comprised the control group. There was a statistically significant difference appreciated in direct comparison of the NWI in the bilateral rupture group and the control group, as well as between the unilateral rupture group and the control group. There was no statistically significant difference between the NWI in the unilateral versus the bilateral rupture group. Conclusion Given the known inconsistencies in the existing literature, our findings provide further support of a narrow NWI as a significant contributing factor to both unilateral and bilateral ACL injury risk in the pediatric and adolescent patient population. Level of Evidence III, retrospective cohort study.
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Affiliation(s)
- Joseph L Yellin
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Robert L Parisien
- Harvard Medical School, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Nakul S Talathi
- University of California Los Angeles Orthopaedic Surgery Residency, Los Angeles, California
| | - Ali S Farooqi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mininder S Kocher
- Harvard Medical School, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
| | - Theodore J Ganley
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
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15
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Fan N, Zheng YC, Zang L, Yang CG, Yuan S, Du P, Liu YM, Zhao Q, Wang JW. What is the impact of knee morphology on posterior cruciate ligament avulsion fracture in men and women: a case control study. BMC Musculoskelet Disord 2021; 22:100. [PMID: 33478440 PMCID: PMC7819342 DOI: 10.1186/s12891-021-03984-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 01/19/2021] [Indexed: 01/11/2023] Open
Abstract
Background Several studies on the relationship between morphological parameters and traumatic diseases of the knee have already been conducted. However, few studies focused on the association between knee morphology and posterior cruciate ligament (PCL) avulsion fracture in adults. The objective of this study was to evaluate the impact of knee morphology on PCL avulsion fracture. Methods 76 patients (comprised 40 men and 36 women) with PCL avulsion fracture and 76 age- and sex-matched controls without PCL avulsion fracture were studied from 2012 to 2020. MRI measurements of the knee were acquired in the sagittal, coronal, and axial planes. The assessed measurements including intercondylar notch width index, coronal tibial slope, and medial/lateral posterior tibial slopes were compared between men and women, and between case and control groups respectively using independent sample t-tests. In addition, binary logistic regression analyses were used to identify independent risk factors of PCL avulsion fracture. Results Except notch width index (coronal) (p = 0.003) in the case groups, there was no statistical difference in the assessed measurements including notch width index (axial), coronal tibial slope, medial posterior tibial slope, and lateral posterior tibial slope between men and women in the case and control groups (p > 0.05). When female patients were analyzed, the notch width index (coronal) was significantly smaller (p = 0.0004), the medial posterior tibial slope (p = 0.018) and the lateral posterior tibial slope (p = 0.033) were significantly higher in the case group. The binary logistic regression analysis showed that the notch width index (coronal) (B = -0.347, OR = 0.707, p = 0.003) was found to be an independent factor of PCL avulsion fracture. However, none of the assessed measurements was found to have a statistical difference between the case and control groups in men (p > 0.05). Conclusions Notch width index (coronal), medial posterior tibial slope, and lateral posterior tibial slope were found to affect PCL avulsion fracture in women, but no such measurements affected the PCL avulsion fracture in men. Furthermore, a smaller notch width index (coronal) in women was found to be a risk factor in PCL avulsion fracture.
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Affiliation(s)
- Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yong-Chen Zheng
- Department of Orthopedics, Beijing Shunyi District Hospital, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Cheng-Gang Yang
- Department of Orthopedics, Beijing Shunyi District Hospital, Beijing, China.
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan-Mei Liu
- Department of Orthopedics, Beijing Shunyi District Hospital, Beijing, China
| | - Qing Zhao
- Department of Orthopedics, Beijing Shunyi District Hospital, Beijing, China
| | - Jin-Wei Wang
- Department of Orthopedics, Beijing Shunyi District Hospital, Beijing, China
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16
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Rakshit J, Agrawal A, Sakale H, Kar B, Raj M. Anatomical considerations of intercondylar notch dimensions of femur in cadavers with intact anterior cruciate ligament. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2021. [DOI: 10.4103/jotr.jotr_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Morphology of the resident's ridge, and the cortical thickness in the lateral wall of the femoral intercondylar notch correlate with the morphological variations of the Blumensaat's line. Knee Surg Sports Traumatol Arthrosc 2020; 28:2668-2674. [PMID: 32157361 DOI: 10.1007/s00167-020-05932-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to reveal the morphological correlation between the lateral wall of femoral intercondylar notch and the Blumensaat's line. METHODS Forty-one non-paired human cadaveric knees were included in this study (23 female, 18 male: median age 83). Knees were resected, and 3 dimensional computed tomography (3D-CT) was performed. In the axial CT image, bony protrusion (resident's ridge) and cortical thickness in the lateral wall of the femoral intercondylar notch were detected. The length between the top of the ridge, or the most anterior, middle, and most posterior border of cortical thickness and posterior femoral condylar line was measured. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight and hill types (small and large hill types). In the hill types, the length between the hilltop and the posterior border of the Blumensaat's line or the posterior border of the femoral condyle was evaluated. Statistical correlation was calculated between the top of the ridge location, cortical thickness location in the notch, and hilltop location. RESULTS There were 7 straight type knees and 34 hill type knees (9 small hill type knees and 25 large hill type knees). Only the hill types of knees were evaluated. The top of the ridge, anterior margin, middle, and posterior border of cortical thickness in the lateral wall of the femoral intercondylar notch existed at 61.8 ± 4.6%, 58.3 ± 12.3%, 42.1 ± 7.9%, and 25.5 ± 5.4% from the posterior condylar line, respectively. The hilltop existed at 24.9 ± 5.9% and 30.7 ± 5.0%, from the posterior border of the Blumensaat's line and from the posterior border of the femoral condyle, respectively. Significant correlation was observed between resident's ridge top, cortical thickness location and hilltop location. CONCLUSION In all cadaveric knees, cortical thickness was detected in the lateral wall of the femoral intercondylar notch. The resident's ridge and cortical thickness location had significant correlation with the hill location in the Blumensaat's line, indicating a continuation of the cortical bone from the posterior cortex of the femoral shaft via the hilltop of the Blumensaat's line to the cortical thickness in the lateral wall of the femoral intercondylar notch. For clinical relevance, hilltop location in the Blumensaat's line is a new bony landmark in anterior cruciate ligament surgery.
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18
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Hosseinzadeh S, Kiapour AM. Sex Differences in Anatomic Features Linked to Anterior Cruciate Ligament Injuries During Skeletal Growth and Maturation. Am J Sports Med 2020; 48:2205-2212. [PMID: 32667272 PMCID: PMC7856525 DOI: 10.1177/0363546520931831] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several anatomic features of the knee have been shown to affect joint and anterior cruciate ligament (ACL) loading and the risk of subsequent injuries. While several studies have highlighted sex differences between these anatomic features, little is known on how these differences develop during skeletal growth and maturation. HYPOTHESES (A) Anatomic features linked to an ACL injury will significantly change during skeletal growth and maturation. (B) The age-related changes in anatomic features linked to an ACL injury are different between male and female patients. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS After institutional review board approval, magnetic resonance imaging data from 269 unique knees (patient age 3-18 years; 51% female), free from any injuries, were used to measure femoral notch width, posterior slope of the lateral tibial plateau (lateral tibial slope), medial tibial depth, tibial spine height, and posterior lateral meniscal bone angle. Linear regression was used to test the associations between age and quantified anatomic indices. Patients were then divided into 4 age groups: preschool (3-6 years), prepubertal (7-10 years), early adolescent (11-14 years), and late adolescent (15-18 years). Also, 2-way analysis of variance with the Holm-Sidak post hoc test was used to compare morphology between male and female patients in each age group. RESULTS The femoral notch width, medial tibial depth, and tibial spine height significantly increased with age (P < .001). The lateral tibial slope decreased with age only in male patients (P < .001). Except for the posterior lateral meniscal bone angle, the age-related changes in anatomy were different between male and female patients (P < .05). On average, early and late adolescent female patients had smaller femoral notches, steeper lateral tibial slopes, flatter medial tibial plateaus, and shorter tibial spines compared with age-matched male patients (P < .01). CONCLUSION Overall, the findings supported our hypotheses, showing sex-specific changes in anatomic features linked to an ACL injury during skeletal growth and maturation. These observations help to better explain the reported age and sex differences in the prevalence of ACL injuries. The fact that most of these anatomic features undergo substantial changes during skeletal growth and maturation introduces the hypothesis that prophylactic interventions (ie, activity modification) would have the potential to reshape a maturing knee in a manner that lowers the risk of noncontact ACL injuries.
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Affiliation(s)
| | - Ata M. Kiapour
- Address correspondence to Ata M. Kiapour, PhD, MMSc, Department of Orthopedic Surgery, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA, ()
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Oshima T, Putnis S, Grasso S, Parker DA. The space available for the anterior cruciate ligament in the intercondylar notch is less in patients with ACL injury. Knee Surg Sports Traumatol Arthrosc 2020; 28:2105-2115. [PMID: 32157364 DOI: 10.1007/s00167-020-05921-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/24/2020] [Indexed: 11/24/2022]
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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Affiliation(s)
- Takeshi Oshima
- Sydney Orthopaedic Research Institute, Level 1, 445 Victoria Avenue, Chatswood, Sydney, NSW, Australia. .,Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Sven Putnis
- Sydney Orthopaedic Research Institute, Level 1, 445 Victoria Avenue, Chatswood, Sydney, NSW, Australia.,Avon Orthopaedic Centre, Bristol, UK
| | - Samuel Grasso
- Sydney Orthopaedic Research Institute, Level 1, 445 Victoria Avenue, Chatswood, Sydney, NSW, Australia.,The University of Sydney, Sydney, Australia
| | - David Anthony Parker
- Sydney Orthopaedic Research Institute, Level 1, 445 Victoria Avenue, Chatswood, Sydney, NSW, Australia.,The University of Sydney, Sydney, Australia
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20
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Montreuil J, Saleh J, Cresson T, De Guise JA, Lavoie F. Femoral Tunnel Placement Analysis in ACL Reconstruction Through Use of a Novel 3-Dimensional Reference With Biplanar Stereoradiographic Imaging. Orthop J Sports Med 2020; 8:2325967120915709. [PMID: 32426408 PMCID: PMC7219010 DOI: 10.1177/2325967120915709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The femoral-sided anatomic footprint of the anterior cruciate ligament (ACL) has been widely studied during the past decades. Nonanatomic placement is an important cause of ACL reconstruction (ACLR) failure. Purpose: To describe femoral tunnel placement in ACLR through use of a comprehensive 3-dimensional (3D) cylindrical coordinate system combining both the traditional clockface technique and the quadrant method. Our objective was to validate this technique and evaluate its reproducibility. Study Design: Descriptive laboratory study. Methods: The EOS Imaging System was used to make 3D models of the knee for 37 patients who had undergone ACLR. We designed an automated cylindrical reference software program individualized to the distal femoral morphology of each patient. Cylinder parameters were collected from 2 observers’ series of 3D models. Each independent observer also manually measured the corresponding parameters using a lateral view of the 3D contours and a 2-dimensional stereoradiographic image for the corresponding patient. Results: The average cylinder produced from the first observer’s EOS 3D models had a 30.0° orientation (95% CI, 28.4°-31.5°), 40.4 mm length (95% CI, 39.3-41.4 mm), and 19.3 mm diameter (95% CI, 18.6-20.0 mm). For the second observer, these measurements were 29.7° (95% CI, 28.1°-31.3°), 40.7 mm (95% CI, 39.7-41.8 mm), and 19.7 mm (95% CI, 18.8-20.6 mm), respectively. Our method showed moderate intertest intraclass correlation among all 3 measuring techniques for both length (r = 0.68) and diameter (r = 0.63) but poor correlation for orientation (r = 0.44). In terms of interobserver reproducibility of the automated EOS 3D method, similar results were obtained: moderate to excellent correlations for length (r = 0.95; P < .001) and diameter (r = 0.66; P < .001) but poor correlation for orientation (r = 0.29; P < .08). With this reference system, we were able to describe the placement of each individual femoral tunnel aperture, averaging a difference of less than 10 mm from the historical anatomic description by Bernard et al. Conclusion: This novel 3D cylindrical coordinate system using biplanar, stereoradiographic, low-irradiation imaging showed a precision comparable with standard manual measurements for ACLR femoral tunnel placement. Our results also suggest that automated cylinders issued from EOS 3D models show adequate accuracy and reproducibility. Clinical Relevance: This technique will open multiple possibilities in ACLR femoral tunnel placement in terms of preoperative planning, postoperative feedback, and even intraoperative guidance with augmented reality.
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Affiliation(s)
- Julien Montreuil
- Laboratoire de recherche en Imagerie et Orthopédie de l'ETS, Montréal, Québec, Canada.,McGill Division of Orthopaedic Surgery, Montréal General Hospital, Montréal, Québec, Canada
| | - Joseph Saleh
- Faculté de Médecine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Thierry Cresson
- Laboratoire de recherche en Imagerie et Orthopédie de l'ETS, Montréal, Québec, Canada
| | - Jacques A De Guise
- Laboratoire de recherche en Imagerie et Orthopédie de l'ETS, Montréal, Québec, Canada
| | - Frédéric Lavoie
- Service de chirurgie orthopédique, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Li F, Qin L, Gong X, Huang Z, Wang T, Liu Z, Sandiford S, Yang J, Zhu S, Liang X, Huang W, Hu N. The Chinese ACL injury population has a higher proportion of small ACL tibial insertion sizes than Western patients. Knee Surg Sports Traumatol Arthrosc 2020; 28:888-896. [PMID: 31111185 PMCID: PMC7035219 DOI: 10.1007/s00167-019-05541-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The study purpose is to characterize the sizes of the anterior cruciate ligament (ACL) insertion site and intercondylar notch in Chinese patients undergoing ACL surgery. The findings will provide a reference for individualized clinical treatment of ACL rupture. METHODS For this study, 137 patients (102 males, 35 females) with an average age of 30.3 ± 9.5 years (range 14-52 years) undergoing ACL reconstruction were included. The tibial ACL insertion site length and width and the intercondylar notch width were measured on MRI and arthroscopically using a ruler. Descriptive statistics of the patients, the distribution of the measurements and the differences between males and females were calculated. RESULTS The ACL tibial insertion size and intercondylar notch width in Chinese patients with ACL injuries, as obtained by MRI and intra-operatively, exhibited significant individual variability. The tibial ACL insertion site had a mean length of 13.5 ± 2.1 mm and width of 10.9 ± 1.5 mm as measured on MRI and a mean length of 13.3 ± 2.1 mm and width of 11.0 ± 1.6 mm as measured intra-operatively. The mean intercondylar notch width was 15.2 ± 2.4 mm on MRI and the mean length was 15.0 ± 2.5 mm intra-operatively. The inter-rater reliability between MRI and intra-operative measurements confirmed that the two methods were consistent. In 65.7% of individuals, the ACL tibial insertion length was < 14 mm. CONCLUSION The distribution of tibial footprint size in Chinese patients is different from that in Western populations. There is a higher proportion of subjects with a tibial footprint size < 14 mm among Chinese patients with ACL injury. Therefore, great care should be taken when treating this population with the double-bundle technique or larger graft options. Level of evidence IV.
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Affiliation(s)
- Feilong Li
- Department of Orthopedics, The Dazu District People'S Hospital, Chongqing, 402360, China.,Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Leilei Qin
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xuan Gong
- Department of Outpatient, Chongqing General Hospital, Chongqing, 400013, China
| | - Zhenggu Huang
- Department of Orthopedics, The Dazu District People'S Hospital, Chongqing, 402360, China
| | - Ting Wang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ziming Liu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Steve Sandiford
- Department of Orthopedics, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Jianye Yang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Sizheng Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xi Liang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ning Hu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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22
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The Blumensaat's line morphology influences to the femoral tunnel position in anatomical ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:3638-3643. [PMID: 30915514 DOI: 10.1007/s00167-019-05492-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to reveal the influence of the morphological variations of the Blumensaat's line on femoral tunnel position in anatomical anterior cruciate ligament (ACL) reconstruction. METHODS Thirty-eight subjects undergoing anatomical single-bundle ACL reconstruction were included in this study (22 female, 16 male: median age 45: 15-63). Using a trans-portal technique, the femoral tunnel was targeted to reproduce the center of antero-medial bundle. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight and hill types (small and large hill types). Femoral ACL tunnel position was evaluated using the quadrant method. When the quadrant method grid was applied, the baseline of the grid was matched to the anterior part of the Blumensaat's line, without considering the existence of a hill. Using pre-operative 3D-CT data, the axial and sagittal morphology of the knee was also compared, establlishing straight and hill types. RESULTS There were 12 straight type knees and 26 hill type knees (7 small hill type knees and 19 large hill type knees). The femoral tunnel position in straight type knees was 23.6 ± 3.7% in the shallow-deep direction, and 41.3 ± 8.2% in the high-low direction. In hill type knees, the tunnel position was 27 ± 4.7% in the shallow-deep direction, and 51 ± 10.1% in the high-low direction. The femoral tunnel was placed significantly more shallow and lower in hill type knees when compared with straight type knees. CONCLUSION Femoral ACL tunnel placement was significantly influenced by the morphological variations of the Blumensaat's line. As detecting morphological variation in arthroscopic surgery is difficult, surgeons should confirm such variations pre-operatively using radiograph or CT so as to avoid making extremely shallow and low tunnels in hill type knees. LEVEL OF EVIDENCE Case-controlled study, III.
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23
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Yahagi Y, Horaguchi T, Iriuchishima T, Suruga M, Iwama G, Aizawa S. Correlation between the mid-substance cross-sectional anterior cruciate ligament size and the knee osseous morphology. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:291-296. [PMID: 31552484 DOI: 10.1007/s00590-019-02552-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION One of the final goals of anatomical anterior cruciate ligament (ACL) reconstruction is the restoration of native anatomy. It is essential to obtain more accurate predictors of mid-substance ACL size before surgery. However, to the best of our knowledge, no study has reported correlation between the mid-substance cross-sectional ACL size and the knee osseous morphology. The purpose of this study was to reveal correlation between the mid-substance cross-sectional ACL size and the knee osseous morphology. MATERIALS AND METHODS We used 39 non-paired formalin fixed Japanese cadaveric knees. All surrounding muscles, ligaments and soft tissues in the knee were resected. After soft tissue resection, the knee was flexed at 90°, and a tangential plane of the femoral posterior condyles was marked and cut the ACL. Femoral ACL footprint size, Blumensaat's line length, lateral wall of the femoral intercondylar notch size, lateral wall of the femoral intercondylar notch height, tibial ACL footprint size, tibia plateau size, the whole anterior-posterior (AP) length, the medial and the lateral AP length of the tibia plateau, and the medial-lateral (ML) length of the tibia plateau were measured. The Pearson's product movement correlation was calculated to reveal correlation between the mid-substance cross-sectional ACL size and the measured parameters of the knee osseous morphology. RESULTS The measured mid-substance cross-sectional ACL size was 49.9 ± 16.3 mm2. The tibial ACL footprint size, the tibia plateau size, the whole AP length of the tibia plateau, the lateral AP length of the tibia plateau and the ML length of the tibia plateau were significantly correlated with the mid-substance cross-sectional ACL size. CONCLUSIONS For clinical relevance, some tibial sides of the knee osseous morphology were significantly correlated with the mid-substance cross-sectional ACL size. It might be possible to predict the mid-substance ACL size measuring these parameters.
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Affiliation(s)
- Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Takashi Horaguchi
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Spa Hospital, Minakami, 198-2, Ishikura Minakami-cho, Tone-Gun, Gunma-ken, 379-1311, Japan.,Department of Functional Morphology, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Makoto Suruga
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Genki Iwama
- Department of Orthopaedic Surgery, Nihon University Hospital, 1-6, Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, 30-1, Ohyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
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24
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van Kuijk KSR, Reijman M, Bierma-Zeinstra SMA, Waarsing JH, Meuffels DE. Posterior cruciate ligament injury is influenced by intercondylar shape and size of tibial eminence. Bone Joint J 2019; 101-B:1058-1062. [PMID: 31474133 DOI: 10.1302/0301-620x.101b9.bjj-2018-1567.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Little is known about the risk factors that predispose to a rupture of the posterior cruciate ligament (PCL). Identifying risk factors is the first step in trying to prevent a rupture of the PCL from occurring. The morphology of the knee in patients who rupture their PCL may differ from that of control patients. The purpose of this study was to identify any variations in bone morphology that are related to a PCL. PATIENTS AND METHODS We compared the anteroposterior (AP), lateral, and Rosenberg view radiographs of 94 patients with a ruptured PCL to a control group of 168 patients matched by age, sex, and body mass index (BMI), but with an intact PCL after a knee injury. Statistical shape modelling software was used to assess the shape of the knee and determine any difference in anatomical landmarks. RESULTS We found shape variants on the AP and Rosenberg view radiographs to be significantly different between patients who tore their PCL and those with an intact PCL after a knee injury. Overall, patients who ruptured their PCL have smaller intercondylar notches and smaller tibial eminences than control patients. CONCLUSION This study shows that differences in the shape of the knee are associated with the presence of a PCL rupture after injury. A smaller and more sharply angled intercondylar notch and a more flattened tibial eminence are related to PCL rupture. This suggests that the morphology of the knee is a risk factor for sustaining a PCL rupture. Cite this article: Bone Joint J 2019;101-B:1058-1062.
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Affiliation(s)
- K S R van Kuijk
- Department of Orthopedic Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.,Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - M Reijman
- Department of Orthopedic Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopedic Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - D E Meuffels
- Department of Orthopedic Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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25
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Wang HM, Shultz SJ, Ross SE, Henson RA, Perrin DH, Schmitz RJ. ACL Size and Notch Width Between ACLR and Healthy Individuals: A Pilot Study. Sports Health 2019; 12:61-65. [PMID: 31526322 DOI: 10.1177/1941738119873631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Given the relatively high risk of contralateral anterior cruciate ligament (ACL) injury in patients with ACL reconstruction (ACLR), there is a need to understand intrinsic risk factors that may contribute to contralateral injury. HYPOTHESIS The ACLR group would have smaller ACL volume and a narrower femoral notch width than healthy individuals after accounting for relevant anthropometrics. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Magnetic resonance imaging data of the left knee were obtained from uninjured (N = 11) and unilateral ACL-reconstructed (N = 10) active, female, collegiate-level recreational athletes. ACL volume was obtained from T2-weighted images. Femoral notch width and notch width index were measured from T1-weighted images. Independent-samples t tests examined differences in all measures between healthy and ACLR participants. RESULTS The ACLR group had a smaller notch width index (0.22 ± 0.02 vs 0.25 ± 0.01; P = 0.004; effect size, 1.41) and ACL volume (25.6 ± 4.0 vs 32.6 ± 8.2 mm3/(kg·m)-1; P = 0.025; effect size, 1.08) after normalizing by body size. CONCLUSION Only after normalizing for relevant anthropometrics, the contralateral ACLR limb had smaller ACL size and narrower relative femoral notch size than healthy individuals. These findings suggest that risk factor studies of ACL size and femoral notch size should account for relevant body size when determining their association with contralateral ACL injury. CLINICAL RELEVANCE The present study shows that the method of the identified intrinsic risk factors for contralateral ACL injury could be used in future clinical screening settings.
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Affiliation(s)
- Hsin-Min Wang
- Department of Sports, National Changhua University of Education, Changhua City, Taiwan
| | - Sandra J Shultz
- Department of Kinesiology & Gateway MRI Center, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Scott E Ross
- Department of Kinesiology & Gateway MRI Center, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Robert A Henson
- Department of Educational Research Methodology, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - David H Perrin
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
| | - Randy J Schmitz
- Department of Kinesiology & Gateway MRI Center, University of North Carolina at Greensboro, Greensboro, North Carolina
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26
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Kızılgöz V, Sivrioğlu AK, Aydın H, Ulusoy GR, Çetin T, Tuncer K. The Combined Effect of Body Mass Index and Tibial Slope Angles on Anterior Cruciate Ligament Injury Risk in Male Knees: A Case-Control Study. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2019; 12:1179544119867922. [PMID: 31427857 PMCID: PMC6681250 DOI: 10.1177/1179544119867922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
Abstract
Introduction: Tibial slope angles (TSAs) have been identified as potential risk factors of
anterior cruciate ligament (ACL) injury in the literature. A higher body
mass index (BMI) might increase the risk of ACL tear because of greater
axial compressive force. The aim of this study was to determine the
relationship of these factors and the combined effect of BMI and TSA in
determination of risk potential for ACL injury. Methods: The preoperative magnetic resonance (MR) images of 81 ACL-injured male knees
and of 68 male individuals with no ACL injuries were evaluated by 2
radiologists to measure the TSA. The Mann-Whitney U-test
was performed to indicate the significant difference in height, weight, and
BMI values. The independent samples t-test was used to
determine the differences between ACL-injured and non-injured groups
regarding TSA values. Odds ratios were calculated by logistic regression
tests, and receiver operating characteristics (ROC) curves revealed the area
under the receiver operating characteristics curve (AUC) values to compare
the relationships of these parameters with ACL injury. Results: Body mass index, lateral tibial slope (LTS), and medial tibial slope (MTS)
were predictive of ACL risk injury. Body mass index alone had the greatest
effect among these parameters, and there were no statistically significant
differences in coronal tibial slope values between the ACL-ruptured and
control groups. The greatest AUC was observed for the combination of BMI,
MTS, and LTS. Conclusions: Body mass index, LTS, and MTS angles were associated with ACL injury risk and
BMI + MTS + LTS together revealed the greatest effect on ACL injury.
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Affiliation(s)
- Volkan Kızılgöz
- Department of Radiology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Ali Kemal Sivrioğlu
- Department of Radiology, Faculty of Medicine, Kocaeli University, Izmit, Turkey
| | - Hasan Aydın
- Department of Radiology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Gökhan Ragıp Ulusoy
- Department of Orthopaedics, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Türkhun Çetin
- Department of Radiology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Kutsi Tuncer
- Department of Orthopaedics, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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27
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Wang HM, Shultz SJ, Ross SE, Henson RA, Perrin DH, Kraft RA, Schmitz RJ. Sex Comparisons of In Vivo Anterior Cruciate Ligament Morphometry. J Athl Train 2019; 54:513-518. [PMID: 31058539 DOI: 10.4085/1062-6050-371-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Females have consistently higher anterior cruciate ligament (ACL) injury rates than males. The reasons for this disparity are not fully understood. Whereas ACL morphometric characteristics are associated with injury risk and females have a smaller absolute ACL size, comprehensive sex comparisons that adequately account for sex differences in body mass index (BMI) have been limited. OBJECTIVE To investigate sex differences among in vivo ACL morphometric measures before and after controlling for femoral notch width and BMI. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty recreationally active men (age = 23.2 ± 2.9 years, height = 180.4 ± 6.7 cm, mass = 84.0 ± 10.9 kg) and 20 recreationally active women (age = 21.3 ± 2.3 years, height = 166.9 ± 7.7 cm, mass = 61.9 ± 7.2 kg) participated. MAIN OUTCOME MEASURE(S) Structural magnetic resonance imaging sequences were performed on the left knee. Anterior cruciate ligament volume, width, and cross-sectional area measures were obtained from T2-weighted images and normalized to femoral notch width and BMI. Femoral notch width was measured from T1-weighted images. We used independent-samples t tests to examine sex differences in absolute and normalized measures. RESULTS Men had greater absolute ACL volume (1712.2 ± 356.3 versus 1200.1 ± 337.8 mm3; t38 = -4.67, P < .001) and ACL width (8.5 ± 2.3 versus 7.0 ± 1.2 mm; t38 = -2.53, P = .02) than women. The ACL volume remained greater in men than in women after controlling for femoral notch width (89.31 ± 15.63 versus 72.42 ± 16.82 mm3/mm; t38 = -3.29, P = .002) and BMI (67.13 ± 15.40 versus 54.69 ± 16.39 mm3/kg/m2; t38 = -2.47, P = .02). CONCLUSIONS Whereas men had greater ACL volume and width than women, only ACL volume remained different when we accounted for femoral notch width and BMI. This suggests that ACL volume may be an appropriate measure of ACL anatomy in investigations of ACL morphometry and ACL injury risk that include sex comparisons.
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Affiliation(s)
- Hsin-Min Wang
- Department of Sports, National Changhua University of Education, Taiwan
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Scott E Ross
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Robert A Henson
- Department of Educational Research Methodology, University of North Carolina at Greensboro
| | - David H Perrin
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | - Robert A Kraft
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Randy J Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro
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28
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Suruga M, Horaguchi T, Iriuchishima T, Iwama G, Yahagi Y, Tokuhashi Y, Aizawa S. The correlation between the femoral anterior cruciate ligament footprint area and the morphology of the distal femur: three-dimensional CT evaluation in cadaveric knees. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:849-854. [PMID: 30701307 DOI: 10.1007/s00590-019-02387-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS "Anatomical" anterior cruciate ligament (ACL) reconstruction is defined as the functional restoration of the ACL to its native dimensions. It is essential to obtain more accurate predictors of ACL size before surgery. The purpose of this study was to investigate the correlation between the native femoral ACL footprint size and the morphology of the distal femur using three-dimensional CT (3D-CT). METHODS Thirty non-paired Japanese human cadaver knees were used. All soft tissues around the knee were resected except the ACL. For the evaluation of femoral condyle morphology, trans-epicondylar length (TEL), notch outlet length, axial notch area, and notch width index were measured using 3D-CT. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch. The ACL was carefully dissected, and the boundaries of the ACL insertion site were outlined on the femoral side. An accurate lateral view of the femoral condyle was photographed with a digital camera. The size of the femoral ACL footprint, length of Blumensaat's line, and the height and area of the lateral wall of the femoral intercondylar notch were measured with ImageJ software. RESULTS Notch height, lateral notch area, and TEL were significantly correlated with the femoral ACL footprint area. Both axial notch area and notch outlet length were significantly correlated with the femoral mid-substance insertion area. CONCLUSION Morphological evaluation using 3D-CT preoperatively may be useful in predicting the femoral ACL footprint size.
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Affiliation(s)
- Makoto Suruga
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-0032, Japan. .,Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan.
| | - Takashi Horaguchi
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | | | - Genki Iwama
- Department of Orthopaedic Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-0032, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
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29
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Iwama G, Iriuchishima T, Horaguchi T, Aizawa S. Measurement of the Whole and Midsubstance Femoral Insertion of the Anterior Cruciate Ligament: The Comparison with the Elliptically Calculated Femoral Anterior Cruciate Ligament Footprint Area. Indian J Orthop 2019; 53:727-731. [PMID: 31673173 PMCID: PMC6804389 DOI: 10.4103/ortho.ijortho_434_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to measure the detailed morphology of the femoral anterior cruciate ligament (ACL) footprint. The correlation and the comparison between the measured area and the area which mathematically calculated as elliptical were also evaluated. MATERIALS AND METHODS Thirty nine nonpaired human cadaver knees were used. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch. The ACL was carefully dissected, and the periphery of the ACL insertion site was outlined on both the whole footprint and the midsubstance insertion. Lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The area, length, and width of the femoral ACL footprint were measured with Image J software (National Institution of Health). Using the length and width of the femoral ACL footprint, the elliptical area was calculated as 0.25 π (length × width). Statistical analysis was performed to reveal the correlation and the comparison of the measured and elliptically calculated area. RESULTS The sizes of the whole and midsubstance femoral ACL footprints were 127.6 ± 41.7 mm2 and 61 ± 20.2 mm2, respectively. The sizes of the elliptically calculated whole and midsubstance femoral ACL footprints were 113.9 ± 4.5 mm2 and 58.4 ± 3 mm2, respectively. Significant difference was observed between the measured and the elliptically calculated area. In the midsubstance insertion, significant correlation was observed between the measured and the elliptically calculated area (Pearson's correlation coefficient = 0.603, P = 0.001). However, no correlation was observed in the whole ACL insertion area. CONCLUSION The morphology of the femoral ACL insertion resembles an elliptical shape. However, due to the wide variation in morphology, the femoral ACL insertion cannot be considered mathematically elliptical.
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Affiliation(s)
- Genki Iwama
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Takanori Iriuchishima
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan,Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan
| | - Takashi Horaguchi
- Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan,Address for correspondence: Dr. Takanori Iriuchishima, Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan. E-mail:
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
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Raja B, Marathe N, Desai J, Dahapute A, Shah S, Chavan A. Evaluation of anatomic risk factors using magnetic resonance imaging in non-contact anterior cruciate ligament injury. J Clin Orthop Trauma 2019; 10:710-715. [PMID: 31316243 PMCID: PMC6611829 DOI: 10.1016/j.jcot.2019.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The purpose of our study was to compare the significance of the tibio-femoral morphological variables (notch width index, notch shape index, intercondylar notch angle, medial and lateral tibial slopes) in predicting non-contact ACL (anterior cruciate ligament) injuries and to compare these factors between genders in South Asian population. The author hopes to provide a comprehensive analysis on the risk factors which would help in betterment of the patients at danger for anterior cruciate ligament injury. MATERIALS AND METHODS A total of 110 MRI knees of patients with 55 subjects of noncontact ACL injury and 55 age and sex matched controls were included in a retrospective study. Notch width index, notch shape index, intercondylar notch angle were assessed in axial and coronal MR imaging along with medial and lateral posterior tibial slopes. Morphology of the notch was also assessed. RESULTS ACL injured group were found to have a statistically significant narrow notch width index and decreased intercondylar notch angle with increased lateral posterior tibial slope. Type-A notches were found to have increased risk of having ACL injuries. Gender comparative results showed no statistically significant differences. CONCLUSION ACL tears are associated with decreased notch width index, intercondylar notch angle and increased lateral posterior tibial slope. Type-A notches are seen to have increased risk for ACL injuries.
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Affiliation(s)
| | - Nandan Marathe
- Corresponding author. Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Saraswati Prasad, Gaul Wada, Vasai (west), Palghar, Maharashtra, 401201, India. Tel.: +91 7738455733.
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31
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Analysis of the risk factors for anterior cruciate ligament injury: an investigation of structural tendencies. Clin Imaging 2018; 50:20-30. [DOI: 10.1016/j.clinimag.2017.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/27/2017] [Accepted: 12/08/2017] [Indexed: 01/12/2023]
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Stenotic intercondylar notch type is correlated with anterior cruciate ligament injury in female patients using magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28646381 DOI: 10.1007/s00167-017-4625-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE AND HYPOTHESIS The principal purpose of this paper was to identify whether femoral notch morphology was different in females without anterior cruciate ligament (ACL) injury from those with ACL injury. Magnetic resonance imaging (MRI) was used to assess the femoral notch type, notch width index and 'α angle' in female patients and measure these differences. METHODS This is a retrospective case control study of 119 female patients, 58 with ACL injury and 61 patients without ACL injury who underwent knee MRI between March 2014 and April 2016. The morphometric measurements were taken by two independent observers. The femoral notch width index was calculated as the ratio between the central notch width and transcondylar or intercondylar width; values >0.27 were considered normal. The femoral notch shape was classified as Type A, Type U or Type W, with Type A describing a stenotic notch, Type U a notch with a wider contour and Type W a wider Type U with two apices apparent. The angle between the longitudinal femoral axis and the Blumensaat line was identified as the 'α angle'. The statistical analysis was performed with t tests, simple and multivariable logistic regression analysis to evaluate the strength of these specific femoral notch morphometric values as predictive factors to ACL rupture. RESULTS Stenotic femoral notch Type A was identified as a high risk factor to ACL injury (odds ratio [OR] = 2.8; p = 0.03). There was no significant difference between the two groups for the notch width index (OR = 0.7; p = n.s.) and the 'α angle' (OR 1.02; p = n.s.). Significant association between NWI and stenotic notch was found (p < 0.01). CONCLUSIONS This study showed that Type A stenotic femoral notch can be considered as a valuable predictive factor for ACL injury. Notch width index and 'α angle' are weak indicators in ACL injury prognosis. Ligament impingement may be inferred as an important mechanism in female ACL rupture. Injury prevention strategies, such as prehabilitation programmes, could be introduced in the benefit of young females with stenotic notch. LEVEL OF EVIDENCE III.
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Li H, Zeng C, Wang Y, Wei J, Yang T, Cui Y, Xie D, Liu H, Lei GH. Association Between Magnetic Resonance Imaging-Measured Intercondylar Notch Dimensions and Anterior Cruciate Ligament Injury: A Meta-analysis. Arthroscopy 2018; 34:889-900. [PMID: 29371012 DOI: 10.1016/j.arthro.2017.08.299] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To explore the association between the magnetic resonance imaging (MRI)-measured intercondylar notch dimensions, including the intercondylar notch width (NW) and intercondylar notch width index (NWI), and the risk of anterior cruciate ligament (ACL) injury by performing a meta-analysis of studies that relied on the multiplanar imaging and soft-tissue visualization strengths of MRI. METHODS The MEDLINE, Embase, and SportDiscus databases were searched from inception to March 2017. Observational studies reporting on the associations of the NWI and NW with ACL injury were retrieved. A random-effects model was used to calculate the overall weighted mean difference (WMD) between the ACL injury group and control group. RESULTS A total of 20 studies were included in this meta-analysis. The combined data showed that subjects with ACL injury, as compared with the control group, had a significantly decreased NW (pooled WMD, -1.53 [95% confidence interval, -1.81 to -1.25]; P < .00001) and NWI (pooled WMD, -0.02 [95% confidence interval, -0.03 to -0.01]; P < .00001). Similar findings were observed in subgroup analyses in terms of different injury mechanisms. No significant difference in NWI was found in the axial view. A significantly decreased NW and NWI were found in other plane views. The sensitivity analyses after the exclusion of studies enrolling only athletes or skeletally immature subjects reached similar outcomes. The Begg rank correlation test showed no publication bias. CONCLUSIONS With the accumulation of evidence, this meta-analysis concluded that the NW and/or NWI measured by MRI was significantly lower in ACL-injured patients than in control subjects. For persons with a narrow intercondylar notch, preventive measures can be prepared for the prevention of ACL injuries. LEVEL OF EVIDENCE Level III, meta-analysis of Level II and III studies.
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Affiliation(s)
- Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China; Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China
| | - Tuo Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Cui
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hua Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Guang-Hua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
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Evaluation of Posterior Cruciate Ligament and Intercondylar Notch in Subjects With Anterior Cruciate Ligament Tear: A Comparative Flexed-Knee 3D Magnetic Resonance Imaging Study. Arthroscopy 2018; 34:557-565. [PMID: 29208323 DOI: 10.1016/j.arthro.2017.08.296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if posterior cruciate ligament (PCL) and intercondylar notch (IN) morphometries and volumetrics act as risk factors for anterior cruciate ligament (ACL) tears. METHODS A prospective case-controlled magnetic resonance imaging (MRI) study was conducted with subjects presenting noncontact knee injuries. Exclusion criteria were previous surgery, PCL tear, osteoarthritis, tumors, or infectious and inflammatory conditions. All participants underwent a flexed-knee 3-dimensional (3D) magnetic resonance imaging (MRI) to uniformly straighten PCL. MR images were independently reviewed by 2 radiologists and assessed for 2D and 3D measurements (bicondylar width; IN angle, depth, width, and cross-sectional area; PCL width, thickness, and cross-sectional area; and IN and PCL volumes). Clinical profiles were tabulated and subjects were divided into cases (ACL tear) and controls (without ACL tear). RESULTS The study was composed of 50 cases versus 52 controls (N = 102), with a mean age of 36.8 years. There was no difference between groups (P > .05) regarding age, gender, body mass index, time from injury, Tegner score, flexion angle, limb side, intensity of injury, or familial or opposite limb history of tear. Agreement between readers ranged from substantial to almost perfect. Subjects with ACL tear presented with lower IN width, lower IN minus PCL widths, lower Notch Width Index, higher PCL/IN width proportion, higher PCL thickness, lower IN depth minus PCL thickness, and higher PCL thickness/IN depth proportion (P < .05). Moreover, higher PCL/IN cross-sectional area proportion, higher PCL volumes (OR = 9.01), and higher PCL/IN volume proportion were also found in cases. CONCLUSIONS Our study shows that subjects with ACL tears present not only reduced IN but also larger PCL dimensions. These findings, isolated and combined, and especially PCL volume, might be suggestive as risk factors for ACL tears owing to the reduction of its space inside the IN. LEVEL OF EVIDENCE Level III, comparative group.
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Yahagi Y, Iriuchishima T, Horaguchi T, Suruga M, Tokuhashi Y, Aizawa S. The importance of Blumensaat's line morphology for accurate femoral ACL footprint evaluation using the quadrant method. Knee Surg Sports Traumatol Arthrosc 2018; 26:455-461. [PMID: 28283721 DOI: 10.1007/s00167-017-4501-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/27/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the difference in the center position of the ACL footprint based on grid placement using the quadrant method according to the morphological variations of the Blumensaat's line. METHODS Fifty-nine non-paired human cadaver knees were used. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch, and the digital images were evaluated using Image J software. The femoral ACL footprint was periphery outlined and the center position was automatically measured. Following Iriuchishima's classification, the morphology of the Blumensaat's line was classified into straight, small hill, and large hill types. From the images, grid quadrants were placed as: Grid (1) without consideration of hill existence and not including the chondral lesion. Grid (2) without consideration of hill existence and including the chondral lesion. Grid (3) with consideration of hill existence and not including the chondral lesion. Grid (4) with consideration of hill existence and including the chondral lesion. RESULTS The straight type consisted of 19 knees, the small hill type 13 knees, and the large hill type 27 knees. Depending on the quadrant grid placement, significant center position difference was observed both in the shallow-deep, and high-low direction. When hill existence was considered, the center position of the ACL was significantly changed to a high position. CONCLUSION The center position of the ACL footprint exhibited significant differences according to Blumensaat's line morphology. For clinical relevance, when ACL surgery is performed in knees with small or large hill type variations, surgeons should pay close attention to femoral tunnel evaluation and placement, especially when using the quadrant method.
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Affiliation(s)
- Yoshiyuki Yahagi
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan. .,Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan.
| | - Takashi Horaguchi
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Makoto Suruga
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
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Lang PJ, Sugimoto D, Micheli LJ. Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children. Open Access J Sports Med 2017; 8:133-141. [PMID: 28652828 PMCID: PMC5476725 DOI: 10.2147/oajsm.s133940] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
As more children and adolescents participate in competitive organized sports, there has been an increase in the reported incidence of anterior cruciate ligament (ACL) injuries in these age groups. ACL injuries in skeletally immature athletes present a challenge, as reconstruction must preserve the physis of the distal femur and of the proximal tibia to avoid growth disturbances. Historically, a skeletally immature athlete with an ACL injury was treated with a brace and activity modification until skeletal maturity, with ACL reconstruction being performed at that time in the “non-copers” who experienced instability. More recently, evidence has shown that delayed reconstruction may lead to increased damage to the meniscus and articular cartilage. As a result, early reconstruction is favored to protect the meniscus and allow continued physical activity. While adolescents at or those near skeletal maturity may be treated with standard reconstruction techniques, they may result in growth disturbances in younger athletes with significant growth remaining. In response to the growing need for ACL reconstruction techniques in skeletally immature individuals, physeal-sparing and physeal-respecting reconstruction techniques have been developed. In addition to the advancements in surgical technique, ACL injury prevention has also gained attention. This growing interest in ACL prevention is in part related to the high risk of ACL re-tear, either of the ACL graft or of the contralateral ACL, in children and adolescents. Recent reports indicate that well-designed neuromuscular training programs may reduce the risk of primary and subsequent ACL injuries.
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Affiliation(s)
- Pamela J Lang
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA
| | - Dai Sugimoto
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Lyle J Micheli
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA.,The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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Orsi AD, Canavan PK, Vaziri A, Goebel R, Kapasi OA, Nayeb-Hashemi H. The effects of graft size and insertion site location during anterior cruciate ligament reconstruction on intercondylar notch impingement. Knee 2017; 24:525-535. [PMID: 28342722 DOI: 10.1016/j.knee.2017.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/28/2017] [Accepted: 02/28/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intercondylar notch impingement is detrimental to the anterior cruciate ligament (ACL). Notchplasty is a preventative remodeling procedure performed on the intercondylar notch during ACL reconstruction (ACLR). This study investigates how ACL graft geometry and both tibial and femoral insertion site location may affect ACL-intercondylar notch interactions post ACLR. A range of ACL graft sizes are reported during ACLR, from six millimeters to 11mm in diameter. Variability of three millimeters in ACL insertion site location is reported during ACLR. This study aims to determine the post-operative effects of minor variations in graft size and insertion location on intercondylar notch impingement. METHODS Several 3D finite element knee joint models were constructed using three ACL graft sizes and polar arrays of tibial and femoral insertion locations. Each model was subjected to flexion, tibial external rotation, and valgus motion. Impingement force and contact area between the ACL and intercondylar notch compared well with experimental cadaver data from literature. RESULTS A three millimeter anterior-lateral tibial insertion site shift of the maximum size ACL increased impingement force by 242.9%. A three millimeter anterior-proximal femoral insertion site shift of the maximum size ACL increased impingement by 346.2%. Simulated notchplasty of five millimeters eliminated all impingement for the simulation with the greatest impingement. For the kinematics applied, small differences in graft size and insertion site location led to large increases in impingement force and contact area. CONCLUSIONS Minor surgical variations may increase ACL impingement. The results indicate that notchplasty reduces impingement during ACLR. Notchplasty may help to improve ACLR success rates.
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Affiliation(s)
- Alexander D Orsi
- Biomechanics Research Group, Northeastern University, 360 Huntington Avenue, Boston, MA, United States
| | - Paul K Canavan
- Department of Rehabilitation, UMass Memorial Hospital, Worcester, MA, United States
| | - Askhan Vaziri
- Biomechanics Research Group, Northeastern University, 360 Huntington Avenue, Boston, MA, United States
| | - Ruben Goebel
- Sports Science Program, Qatar University, Doha, Qatar
| | - Onaly A Kapasi
- Department of Orthopaedic Surgery, Brigham and Women's Faulkner Hospital, Boston, MA, United States
| | - Hamid Nayeb-Hashemi
- Biomechanics Research Group, Northeastern University, 360 Huntington Avenue, Boston, MA, United States.
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The Femoral Intercondylar Notch During Life: An Anatomic Redefinition With Patterns Predisposing to Cruciate Ligament Impingement. AJR Am J Roentgenol 2016; 207:836-845. [DOI: 10.2214/ajr.16.16015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Iriuchishima T, Ryu K, Aizawa S, Fu FH. Blumensaat's line is not always straight: morphological variations of the lateral wall of the femoral intercondylar notch. Knee Surg Sports Traumatol Arthrosc 2016; 24:2752-2757. [PMID: 25805709 DOI: 10.1007/s00167-015-3579-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/06/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the morphological variations of the lateral wall of the femoral intercondylar notch. METHODS Fifty-two non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ACL. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch parallel to the plane of the femoral bone shaft. The ACL was carefully dissected, and the periphery of the ACL insertion site was outlined on the femoral side. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The morphological variations of Blumensaat's line, the height and area of the lateral wall of the femoral intercondylar notch and the size of the femoral ACL footprints were measured with Image J software. RESULTS Blumensaat's line exhibited three types of morphological variations. A straight line was observed in 19 knees (37 %) (straight type). A protrusion spanning less than half of the line was observed at the proximal part of Blumensaat's line in 10 knees (19 %) (small hill type). A protrusion spanning more than half of the line was observed at the proximal part of the line in 23 knees (44 %) (large hill type). In some knees with this large hill type variation, the appearance was similar to that of anterior spur. No significant differences between these three types were observed in either the height and area of the lateral wall of the femoral intercondylar notch or the area of the femoral ACL footprint. CONCLUSION In conclusion, Blumensaat's line has three types of morphological variations (straight, small hill and large hill types). For the clinical relevance, when ACL surgery is performed in knees with small or large hill type variations, surgeons should pay close attention to femoral tunnel evaluation and placement, especially for the use of Quadrant method. The grid placement of Quadrant method would be changed in the knees of these type variations.
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Affiliation(s)
- Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan.
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan.
| | - Keinosuke Ryu
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Tuca M, Hayter C, Potter H, Marx R, Green DW. Anterior cruciate ligament and intercondylar notch growth plateaus prior to cessation of longitudinal growth: an MRI observational study. Knee Surg Sports Traumatol Arthrosc 2016; 24:780-7. [PMID: 26860103 DOI: 10.1007/s00167-016-4021-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/21/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE Increasing numbers of children and adolescents are being treated for ACL tears. In order for surgeons to safely optimize treatment during ACL surgery, we must better understand ACL growth and intercondylar notch patterns in the skeletally immature knee. The aim of this study is to measure ACL and intercondylar notch volume in paediatric patients and observe how these volumes change as a function of age and gender. METHODS Data were extracted from the picture archiving and communication systems (PACS) computer records. Sample consisted of 137 MRI knee examinations performed between January 2006 and July 2010 in patients aged 3-13. Subjects were grouped into 1-year age intervals. Patients with imaging reports including ACL tears, previous surgeries, congenital structural anomalies, or syndromes were excluded. RESULTS Measures of ACL volume significantly increased with age (P < 0.001). A linear increase in ACL volume was observed until the age 10, with a mean increase in volume of 148 mm(3) per age group. ACL volume plateaued at 10 years, after which minimal increase in ACL volume was observed. Sex was not found to be a significant predictor of ACL volume in the multiple linear regression (P = 0.57). Similar to ACL volume, there was a significant increase in intercondylar notch volume with age with a mean increase of 835 mm(3) per age group (P < 0.0001). Intercondylar notch volume reached a plateau at age 10, after which a minimal increase in notch volume was observed in older groups. Female patients had notch volumes that were on average 892 + 259 mm(3) smaller than male patients who were in the same age group (P = 0.0006). CONCLUSION The plateau in the growth of ACL and notch volume occurs at age 10, prior to the halt in longitudinal growth of boys and girls. Female patients have significantly smaller intercondylar notch volumes than their age-matched male counterparts, while no gender difference was seen in ACL volume. These results suggest that notch volume is an intrinsically sex-specific difference, which may contribute to the higher rate of ACL tears among females. These growth patterns are clinically relevant as it allows surgeons to better understand the anatomy, pathology, and risk factors related to ACL tears and its reconstruction. LEVEL OF EVIDENCE Observational Study, Level IV.
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Affiliation(s)
- Maria Tuca
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Manquehue 1410, Santiago, Chile.
| | - Catherine Hayter
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Hollis Potter
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Robert Marx
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Daniel W Green
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Keays SL, Keays R, Newcombe PA. Femoral intercondylar notch width size: a comparison between siblings with and without anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2016; 24:672-9. [PMID: 25542391 DOI: 10.1007/s00167-014-3491-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/12/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries in siblings are commonly observed in the clinic. One, possibly genetic, factor contributing to the pathogenesis of sibling injuries may be narrow intercondylar notches, which are well recognized as predisposing to ACL injury. This study aimed primarily to: (1) assess the incidence of ACL injuries in siblings within an existing study cohort, (2) compare intercondylar notch width size in injured compared to matched uninjured control siblings and (3) compare the number of injured versus control sibling pairs sharing a narrow notch. METHODS Twenty-four ACL-injured siblings from 10 families were matched for age, gender, family composition and sports activity, with 24 uninjured siblings from another 10 families. Intercondylar radiographs were taken to calculate anterior and posterior notch width indices (NWI). Notch size and the number of narrow notches in sibling pairs were compared between groups. RESULTS Thirteen of 72 ACL-study participants had siblings with torn ACLs. Mean anterior NWI was 0.18 and 0.24 (p < 0.001), and mean posterior NWI was 0.26 and 0.3 (p = 0.006) for injured and uninjured siblings, respectively. Sixty percent of injured sibling pairs shared a narrow notch, while no uninjured sibling pairs did so (p = 0.003). CONCLUSION This study showed that siblings (and often sibling pairs) with injuries do have significantly narrower notches than those without. This could partly explain the prevalence of ACL injuries in siblings. To reduce ACL-injury rates, we advise that siblings of ACL-injured athletes with narrow notches, be radiologically screened, and if necessary, cautioned and counselled regarding preventative training. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- S L Keays
- , 60 Netherton St., PO Box 584, Nambour, QLD, 4560, Australia. .,School of Health and Sports Sciences, The University of the Sunshine Coast, Sippy Downs, QLD, Australia.
| | - R Keays
- QE II Hospital, Brisbane, QLD, Australia
| | - P A Newcombe
- School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia
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Erickson BJ, Pham A, Haro MS. Risk of Reinjury or Subsequent Injury After Anterior Cruciate Ligament Reconstruction. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Iriuchishima T, Ryu K, Aizawa S, Fu FH. The difference in centre position in the ACL femoral footprint inclusive and exclusive of the fan-like extension fibres. Knee Surg Sports Traumatol Arthrosc 2016; 24:254-9. [PMID: 25308156 DOI: 10.1007/s00167-014-3373-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to compare the centre position of each anterior cruciate ligament bundle in its femoral footprint in measurements including and excluding the fan-like extension fibres. METHODS Fourteen non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in tension patterns. The ACL was carefully dissected, and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibres. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The centre position of each bundle, including and excluding the fan-like extension fibres, was measured with ImageJ software (National Institution of Health). Evaluation of the centre position was performed using the modified quadrant method. RESULTS The centre of the femoral AM bundle including the fan-like extension was located at 28.8% in a shallow-deep direction and 37.2% in a high-low direction. When the AM bundle was evaluated without the fan-like extension, the centre was significantly different at 34.6% in a shallow-deep direction (p = 0.000) and 36% in a high-low direction. The centre of the PL bundle including the fan-like extension was found at 37.1% in a shallow-deep direction and 73.4% in a high-low direction. When the PL bundle was evaluated without the fan-like extension, the centre was significantly different at 42.7% in a shallow-deep direction (p = 0.000) and 69.3% in a high-low direction (p = 0.000). CONCLUSION The centre position of the AM and PL bundles in the femoral ACL footprint was significantly different depending on the inclusion or exclusion of the fan-like extension fibres. For the clinical relevance, to reproduce the direct femoral insertion in the anatomical ACL reconstruction, tunnels should be placed relatively shallow and high in the femoral ACL footprint.
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Affiliation(s)
| | - Keinosuke Ryu
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Shin Aizawa
- Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburg, PA, USA
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Proportional evaluation of anterior cruciate ligament footprint size and knee bony morphology. Knee Surg Sports Traumatol Arthrosc 2015; 23:3157-62. [PMID: 24951954 DOI: 10.1007/s00167-014-3139-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to reveal the correlation in size between the native anterior cruciate ligament (ACL) footprint and the femoral intercondylar notch and the tibia plateau, and to calculate the proportion in size between the ACL footprint and knee bony morphology. METHODS Twenty-six non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ACL. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch. The ACL was carefully dissected, and the periphery of the ACL insertion site was outlined on both the femoral and tibial sides. An accurate lateral view of the femoral condyle and an axial view of the tibial plateau were photographed with a digital camera, and the images were downloaded to a personal computer. The size of the femoral and tibial ACL footprints and the area of the lateral wall of the intercondylar notch and the tibia plateau were measured with Image J software (National Institution of Health). RESULTS The sizes of the native femoral and tibial ACL footprints were 69.8 ± 25 and 133.8 ± 31.3 mm(2), respectively. The areas of the lateral wall of the intercondylar notch and the tibia plateau were 390.5 ± 70.5 and 2,281.7 ± 377.3 mm(2), respectively. The femoral ACL footprint area and the area of the lateral wall of the femoral intercondylar notch (Pearson's correlation coefficient = 0.603, p = 0.001), and the tibial ACL footprint area and the area of the tibia plateau (Pearson's correlation coefficient = 0.452, p = 0.02) both showed significant correlation. The femoral ACL footprint was 17.8 ± 4.9 %, the size of the lateral wall of the femoral intercondylar notch, and the tibial ACL footprint was 5.9 ± 1.3 %, the size of the tibia plateau. CONCLUSION For clinical relevance, the femoral ACL footprint is approximately 18 %, the size of the intercondylar notch, and the tibial ACL footprint is approximately 6 %, the size of the tibia plateau. It might be possible to predict the size of the ACL measuring these parameters preoperatively.
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Abstract
INTRODUCTION Anterior cruciate ligament tears are one of the most frequent soft tissue injuries of the knee. A torn anterior cruciate ligament leaves the knee joint unstable and at risk for further damage to other soft tissues manifested as pain, dislocation, and osteoarthritis. A better understanding of the anatomical details of knee joints suffering anterior cruciate ligament tears is needed to understand and develop prediction models for anterior cruciate ligament injury and/or tear. MATERIALS AND METHODS Magnetic resonance images of 32 patients with anterior cruciate ligament tears and 40 patients with non-tears were evaluated from a physician group practice. Digital measurements of femoral condyle length, femoral notch width, anterior cruciate ligament width in the frontal and sagittal plane, and the anterior cruciate ligament length in the sagittal plane were taken in both groups to identify trends. Monte Carlo simulations were performed (n = 2000) to evaluate the relationship between notch width index and sagittal width and to establish functional relationships among the anatomical parameters for potential injury risk. Sensitivity analysis performed shows the risk of anterior cruciate ligament injury a function of force and notch width index. RESULTS Females have a significantly shorter anterior cruciate ligament when compared to that of males. The notch width index was also significantly different between torn and non-torn individuals. The NWI was not significantly different between genders (p value = 0.40). CONCLUSIONS Anterior cruciate ligament injury has been shown to be caused by the forces which act on the ligament. These forces can result from hyperextension of the tibia or the internal rotation of tibia. The anatomical parameters of the knee joint (i.e., notch width index, anterior cruciate ligament width and length) have no role in the cause of an injury.
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Affiliation(s)
- K Estes
- Department of Orthopedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA
| | - Bharadwaj Cheruvu
- Department of Biomedical Engineering, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA.
| | - M Lawless
- Department of Orthopedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA
| | - R Laughlin
- Department of Orthopedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA
| | - T Goswami
- Department of Orthopedic Surgery, Sports Medicine, and Rehabilitation, Wright State University, Boonshoft School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA
- Department of Biomedical Engineering, Wright State University, 3640 Colonel Glenn Highway, Dayton, OH, 45435, USA
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Three-Dimensional Femoral Notch Volume in Anterior Cruciate Ligament-Deficient Versus Anterior Cruciate Ligament-Intact Patients: A Matched Case-Control Study With Inter-gender Comparison. Arthroscopy 2015; 31:1117-22. [PMID: 25670337 DOI: 10.1016/j.arthro.2014.12.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 11/24/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate between-gender differences in 3-dimensional femoral notch volume in anterior cruciate ligament (ACL)-deficient patients compared with a matched control group of ACL-intact patients. METHODS Magnetic resonance images from 90 ACL-deficient patients (45 male and 45 female patients) aged 16 to 50 years were identified from our departmental database and then compared with a matched control group of ACL-intact patients. The 3-dimensional femoral notch volume on each magnetic resonance imaging study was measured using software-specific tools. One-way analysis of variance was used to compare notch volume between the ACL-deficient and ACL-intact groups and between the 2 genders. The relations between height, weight, body mass index, and notch volume for each group and within the male and female cohorts were established using Pearson product moment correlations. RESULTS The mean femoral notch volume in the female ACL-deficient group was 3.1 ± 0.70 cm(3) (95% confidence interval [CI], ± 0.2 cm(3)) compared with 3.6 ± 0.7 cm(3) (95% CI, ± 0.2 cm(3)) in the female control group. The mean femoral notch volume in the male ACL-deficient group was 4.5 ± 1.1 cm(3) (95% CI, ± 0.3 cm(3)) compared with 5.3 ± 1.2 cm(3) (95% CI, ± 0.4 cm(3)) in the male control group. There were significant differences between the male ACL-deficient and ACL-intact groups (P = .02), between the female ACL-deficient and ACL-intact groups (P = .0002), between the male and female ACL-deficient groups (P < .0001), and between the male and female ACL-intact groups (P < .0001). There were nonsignificant relations (r = 0.01 to 0.37) between height, weight, body mass index, and notch volume between groups and within the male and female cohorts. CONCLUSIONS These results show a decreased femoral notch volume as measured on 3-dimensional magnetic resonance imaging in ACL-deficient patients. There were significant differences in femoral notch volume between the male and female cohorts, as well as between ACL-deficient and ACL-intact patients of both genders. In the female cohort there was a 14% reduction in volume between the ACL-deficient and ACL-intact patients; in the male cohort there was a 15% corresponding reduction in volume. There was a 31% reduction in volume between genders in ACL-deficient patients, with female patients having a smaller volume than male patients. There was a corresponding 32% reduction in volume between genders in ACL-intact patients. LEVEL OF EVIDENCE Level III, case-control study.
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Iriuchishima T, Ryu K, Aizawa S, Fu FH. Size correlation between the tibial anterior cruciate ligament footprint and the tibia plateau. Knee Surg Sports Traumatol Arthrosc 2015; 23:1147-52. [PMID: 24610536 DOI: 10.1007/s00167-014-2927-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/20/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to reveal the correlation between the size of the native anterior cruciate ligament (ACL) footprint and the size of the tibia plateau. METHODS Twenty-four non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ACL. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch. The ACL was carefully dissected, and the periphery of the ACL insertion site was outlined on both the femoral and tibial sides. An accurate lateral view of the femoral condyle and the tibial plateau was photographed with a digital camera, and the images were downloaded to a personal computer. The size of the femoral and tibial ACL footprints, and anterior-posterior (AP) and medial-lateral (ML), lengths of the tibia plateau and area of tibia plateau were measured with Image J software (National Institution of Health). RESULTS The sizes of the native femoral and tibial ACL footprints were 72.3 ± 24.4 and 134.1 ± 32.4 mm(2), respectively. The AP lengths of the whole, medial and lateral facet of the tibia plateau were as follows: 44.5 ± 4.1, 40.8 ± 4.1 and 36.8 ± 4 mm, respectively. The ML length of the tibia plateau was 68.3 ± 5.5 mm. Total area of tibia plateau was 2,282.9 ± 378.7 mm(2). The AP length of the lateral facet of the tibia plateau (Pearson's correlation coefficient = 0.508, p = 0.011) and the total area of tibia plateau (Pearson's correlation coefficient = 0.442, p = 0.031) were significantly correlated with the size of the tibial ACL footprint. CONCLUSION For clinical relevance, the AP length of lateral facet of the tibia plateau and total area of tibia plateau are significantly correlated with the size of the tibial ACL footprint. It might be possible to predict the size of the ACL measuring these parameters.
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Affiliation(s)
- Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, 198-2 Ishikura, Minakami, Gunma, Japan,
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McLean SG, Mallett KF, Arruda EM. Deconstructing the Anterior Cruciate Ligament: What We Know and Do Not Know About Function, Material Properties, and Injury Mechanics. J Biomech Eng 2015; 137:020906. [DOI: 10.1115/1.4029278] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 12/20/2022]
Abstract
Anterior cruciate ligament (ACL) injury is a common and potentially catastrophic knee joint injury, afflicting a large number of males and particularly females annually. Apart from the obvious acute injury events, it also presents with significant long-term morbidities, in which osteoarthritis (OA) is a frequent and debilitative outcome. With these facts in mind, a vast amount of research has been undertaken over the past five decades geared toward characterizing the structural and mechanical behaviors of the native ACL tissue under various external load applications. While these efforts have afforded important insights, both in terms of understanding treating and rehabilitating ACL injuries; injury rates, their well-established sex-based disparity, and long-term sequelae have endured. In reviewing the expanse of literature conducted to date in this area, this paper identifies important knowledge gaps that contribute directly to this long-standing clinical dilemma. In particular, the following limitations remain. First, minimal data exist that accurately describe native ACL mechanics under the extreme loading rates synonymous with actual injury. Second, current ACL mechanical data are typically derived from isolated and oversimplified strain estimates that fail to adequately capture the true 3D mechanical response of this anatomically complex structure. Third, graft tissues commonly chosen to reconstruct the ruptured ACL are mechanically suboptimal, being overdesigned for stiffness compared to the native tissue. The net result is an increased risk of rerupture and a modified and potentially hazardous habitual joint contact profile. These major limitations appear to warrant explicit research attention moving forward in order to successfully maintain/restore optimal knee joint function and long-term life quality in a large number of otherwise healthy individuals.
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Affiliation(s)
- Scott G. McLean
- Human Performance Innovation Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Kaitlyn F. Mallett
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Ellen M. Arruda
- Department of Mechanical Engineering, Department of Biomedical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
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MRI evaluation of the development of intercondylar notch width in children. Surg Radiol Anat 2015; 37:609-15. [DOI: 10.1007/s00276-015-1433-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/16/2015] [Indexed: 11/25/2022]
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Smaller anterior cruciate ligament diameter is a predictor of subjects prone to ligament injuries: an ultrasound study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:845689. [PMID: 25685812 PMCID: PMC4317588 DOI: 10.1155/2015/845689] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 10/11/2014] [Accepted: 10/11/2014] [Indexed: 12/13/2022]
Abstract
Purpose. To test if diameter of normal anterior cruciate ligament (ACL) can be measured by ultrasound (US), to see if there is a relationship between smaller ACL diameter and ACL injury, and to assess agreement between radiologists in measuring ACL diameter in cases and matched controls. Materials and Methods. In this ethics committee-approved study, maximum diameter of ACL near tibial insertion site was measured by static and dynamic US study in 25 normal contralateral knees of subjects who suffered noncontact ACL injury and in 25 matched control subjects. Results. ACL was visualized as a thick linear hypoechoic band inserted approximately 11 mm caudal to the tibial plateau and the intercondylar eminence. Maximum diameter of contralateral ACL near tibial insertion site among injured subjects was significantly smaller than in noninjured subjects (0.62 ± 0.07 cm versus 0.81 ± 0.06 cm; P < 0.0001). In the regression analysis, the diameter of ACL near tibial insertion site was found significantly proportional to body weight and not significantly associated to height, gender, and age. Conclusion. Diameter of normal ACL near tibial insertion site can be measured by US and the maximum diameter is significantly smaller among subjects with noncontact ACL injury. US is a promising modality that can be used as an excellent screening test to detect subjects especially aspiring athletes prone to ACL injury. Very strong agreement was observed between radiologists in measuring ACL diameter.
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