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Stenotic intercondylar notch type is correlated with anterior cruciate ligament injury in female patients using magnetic resonance imaging

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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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References

  1. Al-Saeed O, Brown M, Athyal R, Sheikh M (2013) Association of femoral intercondylar notch morphology, width index and the risk of anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 21(3):678–682

    Article  PubMed  Google Scholar 

  2. Alentorn-Geli E, Pelfort X, Mingo F, Lizano-Díez X, Leal-Blanquet J, Torres-Claramunt R, Monllau JC (2015) An evaluation of the association between radiographic intercondylar notch narrowing and anterior cruciate ligament injury in men: the notch angle is a better parameter than notch width. Arthroscopy 31(10):2004–2013

    Article  PubMed  Google Scholar 

  3. Cheung EC, Boguszewski DV, Joshi NB, Wang D, McAllister DR (2015) Anatomic factors that may predispose female athletes to anterior cruciate ligament injury. Curr Sports Med Rep 14(5):368–372

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  5. Domzalski M, Grzelak P, Gabos P (2010) Risk factors for anterior cruciate ligament injury in skeletally immature patients: analysis of intercondylar notch width using magnetic resonance imaging. Int Orthop 34(5):703–707

    Article  PubMed  PubMed Central  Google Scholar 

  6. Editorial (2016) The female ACL: why is it more prone to injury? J Orthop 13(2):A1–A4

    Article  Google Scholar 

  7. Fernández-Jaén T, López-Alcorocho JM, Rodriguez-Iñigo E, Castellán F, Hernández JC, Guillén-García P (2015) The importance of the intercondylar notch in anterior cruciate ligament tears. Orthop J Sports Med 3(8):2325967115597882

    Article  PubMed  PubMed Central  Google Scholar 

  8. Freychet B, Lakhal W, Daggett M, Bonnard C (2016) Intercondylar notch dysplasia in open-physis anterior cruciate ligament injuries: a case-control study. Orthop Traumatol Surg Res 102(2):203–206

    Article  CAS  PubMed  Google Scholar 

  9. Hewett TE, Myer GD, Ford KR (2006) Anterior cruciate ligament injuries in female athletes: part 1, mechanisms and risk factors. Am J Sports Med 34(2):299–311

    Article  PubMed  Google Scholar 

  10. Hoteya K, Kato Y, Motojima S, Ingham SJ, Horaguchi T, Saito A, Tokuhashi Y (2011) Association between intercondylar notch narrowing and bilateral anterior cruciate ligament injuries in athletes. Arch Orthop Trauma Surg 131(3):371–376

    Article  PubMed  Google Scholar 

  11. Huston LJ, Greenfield ML, Wojtys EM (2000) Anterior cruciate ligament injuries in the female athlete. Potential risk factors. Clin Orthop Relat Res 372:50–63

    Article  Google Scholar 

  12. Ireland ML, Ballantyne BT, Little K, McClay IS (2001) A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 9(4):200–205

    Article  CAS  PubMed  Google Scholar 

  13. Miljko M, Grle M, Kozul S, Kolobarić M, Djak I (2012) Intercondylar notch width and inner angle of lateral femoral condyle as the risk factors for anterior cruciate ligament injury in female handball players in Herzegovina. Coll Antropol 36(1):195–200

    PubMed  Google Scholar 

  14. Pappas E, Shiyko MP, FordK R, Myer GD, Hewett TE (2016) Biomechanical deficit profiles associated with ACL injury risk in female athletes. Med Sci Sports Exerc 48(1):107–113

    Article  PubMed  PubMed Central  Google Scholar 

  15. Park JS, Nam DC, Kim DH, Kim HK, Hwang SC (2012) Measurement of knee morphometrics using MRI: a comparative study between ACL-injured and non-injured knees. Knee Surg Relat Res 24(3):180–185

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shaw KA, Dunoski B, Mardis N, Pacicca D (2015) Knee morphometric risk factors for acute anterior cruciate ligament injury in skeletally immature patients. J Child Orthop 9(2):161–168

    Article  PubMed  PubMed Central  Google Scholar 

  17. Smith HC, Vacek P, Johnson RJ, Slauterbeck JR, Hashemi J, Shultz S, Beynnon BD (2012) Risk factors for anterior cruciate ligament injury: a review of the literature-part 2: hormonal, genetic, cognitive function, previous injury and extrinsic risk factors. Sports Health 4(2):155–161

    Article  PubMed  PubMed Central  Google Scholar 

  18. Smith HC, Vacek P, Johnson RJ, Slauterbeck JR, Hashemi J, Shultz S, Beynnon BD (2012) Risk factors for anterior cruciate ligament injury: a review of the literature—part 1: neuromuscular and anatomic risk. Sports Health 4(1):69–78

    Article  PubMed  PubMed Central  Google Scholar 

  19. Souryal TO, Moore HA, Evans JP (1988) Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis. Am J Sports Med 16(5):449–454

    Article  CAS  PubMed  Google Scholar 

  20. Staeubli HU, Adam O, Becker W, Burgkart R (1999) Anterior cruciate ligament and intercondylar notch in the coronal oblique plane: anatomy complemented by magnetic resonance imaging in cruciate ligament-intact knees. Arthroscopy 15(4):349–359

    Article  CAS  PubMed  Google Scholar 

  21. Sturnick DR, Vacek PM, DeSarno MJ, Gardner-Morse MG, Tourville TW, Slauterbeck JR, Johnson RJ, Shulz SJ, Beynnon BD (2015) Combined anatomic factors predicting risk of anterior cruciate ligament injury for males and females. Am J Sports Med 43(4):839–847

    Article  PubMed  Google Scholar 

  22. Sutton K, Bullock JM (2013) Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg 21(1):41–50

    Article  PubMed  Google Scholar 

  23. Swami VG, Mabee M, Hui C, Jaremko JL (2013) Three-dimensional intercondylar notch volumes in a skeletally immature pediatric population: a magnetic resonance imaging-based anatomic comparison of knees with torn and intact anterior cruciate ligaments. Arthroscopy 29(12):1954–1962

    Article  PubMed  Google Scholar 

  24. van Diek FM, Wolf MR, Murawski CD, van Eck CF, Fu FH (2014) Knee morphology and risk factors for developing an anterior cruciate ligament rupture: an MRI comparison between ACL-ruptured and non-injured knees. Knee Surg Sports Traumatol Arthrosc 22(5):987–994

    PubMed  Google Scholar 

  25. van Eck CF, Martins CAQ, Vyas SM, Celentano U, van Dijk CN, Fu FH (2010) Femoral intercondylar notch shape and dimensions in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 18(9):1257–1262

    Article  PubMed  Google Scholar 

  26. Vrooijink SH, Wolters F, Van Eck CF, Fu FH (2011) Measurements of knee morphometrics using MRI and arthroscopy: a comparative study between ACL-injured and non-injured subjects. Knee Surg Sports Traumatol Arthrosc 19(Suppl 1):S12–S16

    Article  PubMed  Google Scholar 

  27. Whitney DC, Sturnick DR, Vacek PM, DeSarno MJ, Gardner-Morse M, Tourville TW, Smith HC, Slauterbeck JR, Johnson RJ, Shiltz SJ, Hashemi J, Beynnon BD (2014) Relationship between the risk of suffering a first-time noncontact ACL injury and geometry of the femoral notch and ACL: a prospective cohort study with a nested case-control analysis. Am J Sports Med 42(8):1796–1805

    Article  PubMed  Google Scholar 

  28. Zeng C, Gao S, Wei J, Yang T, Cheng L, Luo W, Tu M, Xie Q, Hu Z, Liu PF, Li H, Yang P, Zhou B, Lei GH (2013) The influence of the intercondylar notch dimensions on injury of the anterior cruciate ligament: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 21(4):804–815

    Article  PubMed  Google Scholar 

  29. Zeng C, Lei G (2015) Comment on “Association of femoral intercondylar notch morphology, width index and the risk of anterior cruciate ligament injury”. Knee Surg Sports Traumatol Arthrosc 23(4):1263–1264

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Trauma and Orthopaedics Department, Homerton University Hospital, Homerton Row, London, E9 6SR, UK

    Theodoros Bouras

  2. AMR Advanced Medical Research, Hofenstrasse 89b, 8708, Männedorf, Switzerland

    Peter Fennema

  3. Radiology Department, Homerton University Hospital, Homerton Row, London, E9 6SR, UK

    Stephen Burke

  4. Trauma and Orthopaedics Department, Broomfield Hospital, Chelmsford, CM1 7ET, UK

    Hilary Bosman

Authors
  1. Theodoros Bouras
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  2. Peter Fennema
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Correspondence to Theodoros Bouras.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national recearch committee and with the 1964 Helsinki declaration and its later amendements or comparable ethical standards. For this study formal consent is not required.

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Bouras, T., Fennema, P., Burke, S. et al. Stenotic intercondylar notch type is correlated with anterior cruciate ligament injury in female patients using magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 26, 1252–1257 (2018). https://doi.org/10.1007/s00167-017-4625-4

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  • DOI: https://doi.org/10.1007/s00167-017-4625-4

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