Comparison of 3-Dimensional Notch Volume Between Subjects With and Subjects Without Anterior Cruciate Ligament Rupture

doi:10.1016/j.arthro.2011.03.085

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 27, Issue 9, September 2011, Pages 1235-1241

https://doi.org/10.1016/j.arthro.2011.03.085 Get rights and content

Purpose

The aim of this study was to determine whether individuals with anterior cruciate ligament (ACL) injuries have smaller notch volumes than uninjured subjects. A secondary aim was to determine the correlation between intraoperative 2-dimensional (2D) notch measurements, patient demographic factors, and notch volume.

Methods

Manual digital tracings of the femoral intercondylar notch perimeter were performed on axial magnetic resonance images to calculate 3-dimensional (3D) notch volume. Notch volume was compared between 50 patients with ACL injury and 50 patients without ACL injury (control subjects). From the 50 patients with ACL injury, intraoperative 2D measurements of the notch were taken. These 2D measurements and patient demographic factors were correlated to 3D notch volume, by use of the Pearson correlation coefficient. In addition, notch size was compared between men and women. All group comparisons were performed by use of unpaired t tests.

Results

The notch volume was larger (6.5 ± 1.7 cm³ [mean ± SD]) for the group with ACL injury compared with control subjects (5.9 ± 1.4 cm³); this difference approached statistical significance (P = .054). There were no significant correlations between the 2D dimensions and the 3D notch volume. Larger notch volumes were significantly correlated with increased subject height (r = 0.636, P < .001) and weight (r = 0.364, P < .001) but not body mass index (P = .269). Male patients had significantly larger notch volumes than female patients (P < .001).

Conclusions

Contrary to our hypothesis, there was a trend toward larger notch volumes in patients with ACL injury compared with patients without ACL injury. Intraoperative notch measurements did not correlate with 3D notch volume. Notch volume was related to patient height, weight, and gender but not body mass index.

Level of Evidence

Level III, case-control study.

Section snippets

Methods

To measure 3D notch volume, a technique similar to that previously described by Charlton et al.¹¹ was used. Manual digital tracings of the femoral intercondylar notch perimeter were performed on the axial magnetic resonance images by use of open-source imaging software (OsiriX, Geneva, Switzerland; available free for Apple MacOS X [Apple, Cupertino, CA] from http://www.osirix-viewer.com/). Notch volume was calculated by summing the measured areas of the notch outlines from each slice and

Results

Table 2 displays the demographic data and the measured notch dimensions for the ACL-injured and control groups; there were 50 subjects in each group. The ACL-injured group included 19 women and 31 men, whereas the control group included 26 women and 24 men. There was no significant difference in gender distribution between the 2 groups. However, the subjects in the control group had a higher BMI (28 v 25, P = .004) and were older (40 v 27 years, P = .001) than those with ACL ruptures. The notch

Discussion

The primary aim of this study was to determine whether there is a difference in 3D notch size between subjects with ACL injury and those without ACL injury. Contrary to our hypothesis, we found no difference in notch size between ACL-injured subjects and non–ACL-injured control subjects.

This study is the first to investigate the relation between ACL injury and notch size assessed using a 3D volumetric technique. The study focused on notch volume because 2D measurement techniques are inherently

Conclusions

Acknowledgment

The authors thank James J. Irrgang, P.T., Ph.D., A.T.C., F.A.P.T.A, for his helpful discussion.

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Cited by (53)

Notch Volume Measured on Magnetic Resonance Imaging Is Better Than 2-Dimensional Notch Parameters for Predicting Noncontact Anterior Cruciate Ligament Injury in Males
2021, Arthroscopy - Journal of Arthroscopic and Related Surgery
To evaluate and compare intercondylar notch volume with other 2-dimensional notch parameters (measured on magnetic resonance imaging [MRI]) for prediction of noncontact anterior cruciate ligament (ACL) injury in males.
Retrospective case-control study in males based on MRI images. The case group consisted of 80 noncontact ACL-injured males and a control group of 80 age- and height-matched ACL-intact males. Inclusion criteria were 18 to 50 years old, full-thickness tear, MRI obtained within 1 year of injury, and ACL tear visually documented during arthroscopy. Multiligamentous, bilateral, or concomitant bony injuries were excluded. Notch volume and 2D parameters in both planes, including notch depth, notch width, intercondylar notch angle, notch-width index, and notch-shape index, were measured on MRI and compared. Slice interval was included in the formula for notch-volume assessment. Bivariate Pearson correlation between notch volume and 2D parameters was estimated. Multivariate conditional logistic regression analysis was used for predictor model. Receiver operating characteristic (ROC) curves were plotted.
All MRIs had a standard slice thickness of 3 mm and slice interval of 0.3 mm. Notch volume (P < .001), notch angle in the axial plane (P = .001), and notch width in the coronal plane (P = .009) were significantly smaller in the ACL-injured group. Notch volume had inconsistent and negligible to low correlation with 2D parameters. Notch volume was the only significant contributor in the predictor model (P < .001). ROC curve showed that notch volume had highest area under the curve of 84.1% and optimal cutoff at 7.1550 cm³ (specificity, 88.7%; sensitivity, 65%).
Significantly smaller intercondylar notch volume is associated with noncontact ACL injury in men and is the most important predictor for such an injury (optimal cutoff of 7.1550 cm³). Two-dimensional notch parameters are inconsistently associated with noncontact ACL injury in men, and none of the 2D parameters can be used as a surrogate for notch volume. Two-dimensional notch parameters fare poorly in predicting noncontact ACL injury in males. Notch volume measurement should include slice interval as a factor.
III, retrospective case-control study.
A narrow intercondylar gap favours anterior cruciate ligament (ACL) rupture in patients with an immature skeleton
2021, Revista Espanola de Cirugia Ortopedica y Traumatologia
Se han reportado factores de riesgo anatómicos que predisponen a rotura del ligamento cruzado anterior (LCA) y/o fracturas avulsivas de espinas tibiales (FAET) en pacientes pediátricos con resultados controversiales. Nuestro objetivo es comparar parámetros morfométricos en resonancia magnética (RM) de pacientes con esqueleto inmaduro que presenten FAET o rotura del LCA versus controles sanos.
Estudio observacional de una cohorte transversal donde se recolectaron de forma consecutiva todos los pacientes con esqueleto inmaduro que presentaron una rotura del LCA o una FAET. Se agregó un grupo control de pacientes con fisis abierta y RM sin evidencia de lesión. Un observador entrenado midió en cada una de las RM con técnica previamente estandarizada: a) el ancho de la escotadura intercondílea femoral, y b) el ángulo de apertura de la escotadura intercondílea femoral.
La muestra se compuso de 11 pacientes con rotura del LCA, 11 pacientes con FAET y 11 controles normales. El ángulo de apertura de la escotadura intercondílea femoral, medido en cortes axiales y coronales, fue significativamente menor en los pacientes con rotura del LCA versus controles sanos (p = 0,0256 y p = 0,0097). El resto de las variables estudiadas no presentaron diferencias significativas entre grupos.
En pacientes con esqueleto inmaduro una escotadura intercondílea femoral más estrecha se asocia a rotura del LCA, mientras que aquellos con una FAET no presentan una anatomía ósea distintiva versus los controles sanos. Estos hallazgos sugieren que parámetros morfométricos óseos se asocian a un patrón lesional u otro en rodillas con fisis abierta.
Anatomical risk factors predisposing to anterior cruciate ligament (ACL) and/or avulsion fractures of tibial spines (AFET) have been reported in paediatric patients with controversial results. Our aim is to compare morphometric parameters in magnetic resonance imaging (MRI) of patients with immature skeleton presenting AFET or ACL rupture versus healthy controls.
Observational study of a transverse cohort where all those patients with immature skeleton presenting ACL rupture or AFET were collected consecutively. A control group of patients with open physis and MRI reported without lesions was added. A trained observer measured in each MRI with previously standardized technique: a) the width of the intercondylar femoral notch, and b) the opening angle of the intercondylar femoral notch.
The sample was composed of 11 patients with ACL rupture, 11 patients with TEA and 11 normal controls. The opening angle of the intercondylar femoral notch, measured in axial and coronal sections, was significantly lower in those patients with ACL rupture versus healthy controls (P = .0256 and P = .0097). The rest of the variables studied did not present significant differences between groups.
In patients with an immature skeleton, a narrower femoral intercondylar notch is associated with ACL rupture, while those with an ETF do not present a distinctive bone anatomy versus healthy controls. These findings suggest that bone morphometric parameters are associated with a lesional or other pattern in open-knee.
Anterior Cruciate Ligament Injuries: Sex-Based Differences
2021, The Female Athlete
Injury to the anterior cruciate ligament (ACL) results in significant impairment necessitating a prolonged course of surgical reconstruction and rehabilitation to achieve return to play. In spite of many advancements in prevention, surgical management, and rehabilitation, females continue to experience higher rates of ACL injury than males. Many factors, including hormonal, morphologic, and neurophysiologic differences, have been postulated to result in such disparities between genders. This chapter highlights such differences and outlines specific steps toward the successful management of female ACL injuries.
Enlarged tibial eminence may be a protective factor of anterior cruciate ligament
2020, Medical Hypotheses
Anterior cruciate ligament (ACL) is a primary stabilizer of the knee and constrains joint motion, and its injury is very common in clinic. There are many studies on the risk factors of ACL injury such as the ACL diameter, intercondylar notch width index (NWI), sagittal condylar shape, tibial posterior slope, tibia eminence size and so on. Large amount of research data has confirmed that all above are closely related to ACL injury. Among them the morphological characteristics of femoral condyle and tibial plateau are closely related to ACL injury. For example the tibial eminence, which is the hot topic of recent research. Whether or how does it relate to ACL injury has draw much interest of researchers. Since the tibial eminence and the ACL are both located in the intercondylar notch and adjacent to each other, we hypothesize the size of the tibial eminence may relate to the rupture of ACL. For there is report have found that reduced medial tibial eminence was associated with ACL injury, we suggest a hypothesis that enlarged tibia eminence may be a protective factor of ACL.
Association Between Magnetic Resonance Imaging–Measured Intercondylar Notch Dimensions and Anterior Cruciate Ligament Injury: A Meta-analysis
2018, Arthroscopy - Journal of Arthroscopic and Related Surgery
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.
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.
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.
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 III, meta-analysis of Level II and III studies.
Evaluation of Posterior Cruciate Ligament and Intercondylar Notch in Subjects With Anterior Cruciate Ligament Tear: A Comparative Flexed-Knee 3D Magnetic Resonance Imaging Study
2018, Arthroscopy - Journal of Arthroscopic and Related Surgery
To determine if posterior cruciate ligament (PCL) and intercondylar notch (IN) morphometries and volumetrics act as risk factors for anterior cruciate ligament (ACL) tears.
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).
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.
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 III, comparative group.

View all citing articles on Scopus

: Supported by Smith & Nephew for research related to ACL reconstruction. The authors report no conflict of interest.

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Original ArticleComparison of 3-Dimensional Notch Volume Between Subjects With and Subjects Without Anterior Cruciate Ligament Rupture

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgment

J Biomech

Arthroscopy

Arthroscopy

Knee

Structure and vascularization of the cruciate ligaments of the human knee joint

Anat Embryol (Berl)

Injury mechanisms for anterior cruciate ligament injuries in team handball: A systematic video analysis

Am J Sports Med

Analysis of the intercondylar notch by computed tomography

Am J Sports Med

The intercondylar notch in acute tears of the anterior cruciate ligament: A computer graphics study

Am J Sports Med

Intercondylar notch stenosis is not a risk factor for anterior cruciate ligament tears in professional male basketball players: An 11-year prospective study

Am J Sports Med

Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears

Knee Surg Sports Traumatol Arthrosc

The relationship between intercondylar notch width of the femur and the incidence of anterior cruciate ligament tearsA prospective study

Am J Sports Med

Original Article
Comparison of 3-Dimensional Notch Volume Between Subjects With and Subjects Without Anterior Cruciate Ligament Rupture