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Crouser N, Wright J, DiBartola A, Flanigan D, Duerr R. Intercondylar Notch Pathology. J Knee Surg 2024; 37:149-157. [PMID: 36539213 DOI: 10.1055/a-2001-6764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The intercondylar notch of the knee is a relatively small area. However, numerous rare pathologies can arise in this region. A majority of the existing literature has focused on the cruciate ligament injuries, yet there are several other entities that can cause knee pain from within the intercondylar notch. This review focuses on identifying the various diagnostic and treatment options for rare benign and malignant lesions including ganglion cyst formation, mucoid degeneration, benign proliferative conditions, and intra-articular tumors. These entities are most often diagnosed with advanced imaging studies and treated arthroscopically. While rare, these pathologies are important to identify in patients with ongoing vague knee pain.
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Affiliation(s)
- Nisha Crouser
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jonathan Wright
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alex DiBartola
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert Duerr
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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2
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Pryymachenko Y, Wilson R, Abbott JH. Epidemiology of cruciate ligament injuries in New Zealand: exploring differences by ethnicity and socioeconomic status. Inj Prev 2022; 29:213-218. [PMID: 36564166 DOI: 10.1136/ip-2022-044761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/10/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To investigate the temporal trends and ethnic and socioeconomic disparities in cruciate ligament (CL) injury incidence and associated costs in New Zealand over a 14-year period. METHODS All CL injury claims lodged between 2007 and 2020 were extracted from the Accident Compensation Corporation (a nationwide no-fault injury compensation scheme) claims dataset. Age-adjusted and sex-adjusted incidence rates, total injury costs and costs per claim were calculated for each year for total population and subgroups. RESULTS The total number of CL injury claims increased from 6972 in 2007 to 8304 in 2019, then decreased to 7068 in 2020 (likely due to widespread COVID-19 restrictions; analysis is therefore restricted to 2007-2019 hereafter). The (age-adjusted and sex-adjusted) incidence rate remained largely unchanged and was 173 cases per 100 000 people in 2019. There was a 127% increase in total injury claims costs and a 90% increase in costs per claim. Pacific people had the highest incidence rate and costs per 100 000 people, while Asians had the lowest; European, Māori and 'other' ethnicities had similar incidence rates and total costs. Incidence rates and total costs increased with income and decreased with neighbourhood deprivation. Costs per claim differed little by ethnicity, but increased with income level. CONCLUSION The number and costs of CL injury claims in New Zealand are increasing. There are ethnic and socioeconomic disparities in CL incidence rates and costs, which are important to address when designing CL injury prevention programmes and programmes aimed at improving equity of access to medical care.
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Affiliation(s)
- Yana Pryymachenko
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - Ross Wilson
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
| | - J Haxby Abbott
- Department of Surgical Sciences, University of Otago, Dunedin, New Zealand
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Devana SK, Solorzano C, Nwachukwu B, Jones KJ. Disparities in ACL Reconstruction: the Influence of Gender and Race on Incidence, Treatment, and Outcomes. Curr Rev Musculoskelet Med 2022; 15:1-9. [PMID: 34970713 PMCID: PMC8804118 DOI: 10.1007/s12178-021-09736-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Anterior cruciate ligament (ACL) rupture is a common injury that has important clinical and economic implications. We aimed to review the literature to identify gender, racial and ethnic disparities in incidence, treatment, and outcomes of ACL injury. RECENT FINDINGS Females are at increased risk for ACL injury compared to males. Intrinsic differences such as increased quadriceps angle and increased posterior tibial slope may be contributing factors. Despite lower rates of injury, males undergo ACL reconstruction (ACLR) more frequently. There is conflicting evidence regarding gender differences in graft failure and ACL revision rates, but males demonstrate higher return to sport (RTS) rates. Females report worse functional outcome scores and have worse biomechanical metrics following ACLR. Direct evidence of racial and ethnic disparities is limited, but present. White athletes have greater risk of ACL injury compared to Black athletes. Non-White and Spanish-speaking patients are less likely to undergo ACLR after ACL tear. Black and Hispanic youth have greater surgical delay to ACLR, increased risk for loss to clinical follow-up, and less physical therapy sessions, thereby leading to greater deficits in knee extensor strength during rehabilitation. Hispanic and Black patients also have greater risk for hospital admission after ACLR, though this disparity is improving. Females have higher rates of ACL injury with inconclusive evidence on anatomic predisposition and ACL failure rate differences between genders. Recent literature has suggested inferior RTS and functional outcomes following ACLR in females. Though there is limited and mixed data on incidence and outcome differences between races and ethnic groups, recent studies suggest there may be disparities in those who undergo ACLR and time to treatment.
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Affiliation(s)
- Sai K. Devana
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Carlos Solorzano
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
| | - Benedict Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, USA
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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: 0] [Impact Index Per Article: 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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Correlation between notch width index assessed via magnetic resonance imaging and risk of anterior cruciate ligament injury: an updated meta-analysis. Surg Radiol Anat 2020; 42:1209-1217. [PMID: 32444935 DOI: 10.1007/s00276-020-02496-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To analyze the correlation between notch width index (NWI) and/or femoral intercondylar notch width (NW) assessed by magnetic resonance imaging (MRI) and risk of anterior cruciate ligament (ACL) injury. METHODS We searched the PubMed, Embase, China National Knowledge Infrastructure and Wanfang databases for literature reporting a correlation between ACL injury and NWI and/or NW. Subgroup analyses were stratified by ethnicity, sex and control source. The weighted mean difference (WMD) and 95% confidence intervals (95% CIs) were calculated for the ACL injury cases and controls using random- or fixed-effects models. Begg's test and sensitivity analyses were applied to assess publication bias and stability of the results, respectively. RESULTS Twenty-eight eligible studies were finally enrolled. The NW was significantly narrowerin the ACL injury cases than in the control cases (pooled WMD, - 1.88 [95% CI, - 2.43 to - 1.32]). The results were similar when stratified by ethnicity and sex. Similarly, the NWI was lower in ACL injury cases than in the controls. Asian populations presented similar results when stratified by ethnicity, among the self-control group when stratified by control source, and among men when stratified by sex. No publication bias was identified; however, the sensitivity analysis suggested unstable results in the NWI subgroup analysis. CONCLUSIONS The current meta-analysis evidenced that the NW assessed via MRI was significantly smaller in ACL injury cases than in the controls. The NWI was lower in ACL injury cases among men. Prevention strategies for ACL injury could be applied for people with intercondylar notch stenosis.
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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: 0.5] [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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Contralateral and siblings' knees are at higher risk of ACL tear for patients with a positive history of ACL tear. Knee Surg Sports Traumatol Arthrosc 2020; 28:622-628. [PMID: 31724093 DOI: 10.1007/s00167-019-05781-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/29/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Recent studies have shown that several genetic factors can cause susceptibility to anterior cruciate ligament (ACL) rupture. The aim of the present study was to evaluate certain underlying factors that increase the risk of ACL rupture. METHODS Eight hundred thirty-six patients with ACL rupture who underwent ACL reconstructive surgery from 2010 to 2013 at an academic center completed a minimum of 5 years post-operation follow-up. The collected variables included sex, age, height, weight, exercise level, time interval between ACL rupture in the first knee and contralateral ACL rupture, dominant leg, side of the involved knee and sibling history of ACL rupture. RESULTS The median follow-up duration was 6.5 (range: 5-8) years. Eighty-three patients (9.9%) had a contralateral ACL rupture, and 155 patients (18.5%) had siblings with a history of ACL rupture. The rate of contralateral ACL rupture was three times higher in women than in men and in patients with siblings with a history of ACL rupture than in those without such history. In addition, the risk of contralateral ACL rupture was higher in those younger than 30 years of age, those with a BMI of 20-25 kg/m2 and those who participated in regular sports activity. However, whether the involved knee was on the dominant or nondominant side had no effect on the incidence of contralateral ACL rupture. The results of the study showed that 69 (83.1%) of the contralateral ACL ruptures occurred within the first 2 years after the primary operation. CONCLUSION In a 5- to 8-year follow-up, one out of every ten patients had a contralateral ACL rupture, and two out of every ten patients had siblings with a history of ACL rupture. The findings suggest that having a sibling with a history of ACL rupture and being female are important risk factors for ACL rupture of the contralateral knee. LEVEL OF EVIDENCE III.
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8
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Herzberg SD, Motu'apuaka ML, Lambert W, Fu R, Brady J, Guise JM. The Effect of Menstrual Cycle and Contraceptives on ACL Injuries and Laxity: A Systematic Review and Meta-analysis. Orthop J Sports Med 2017; 5:2325967117718781. [PMID: 28795075 PMCID: PMC5524267 DOI: 10.1177/2325967117718781] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Women are at substantially greater risk for anterior cruciate ligament (ACL) injuries than are men. PURPOSE To conduct a systematic review and meta-analysis of the literature to clarify the effect of the menstrual cycle and contraceptives on the laxity of and noncontact injuries to the ACL. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Searches were conducted using MEDLINE (1946-August 2016), the Cochrane Library Database, clinical trial registries, and related reference lists. Search terms included athletic injuries, knee injuries, ligaments, joint instability, menstrual cycle, ovulation, hormones, and contraceptives. Investigators independently dually abstracted and reviewed study details and quality using predefined criteria and evaluated overall strength of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. RESULTS Twenty-one studies totaling 68,758 participants were included: 5 on the menstrual cycle and ACL injury, 7 on hormonal contraceptives and ACL injury, as well as 13 on menstrual cycle and ligament laxity. Four of 5 studies of women not using hormonal contraception indicated that the luteal phase was the least associated with ACL injuries. The 2 largest and highest quality studies on hormonal contraceptives suggested that hormonal contraceptives may be protective against ACL injury. Six of 12 studies on ACL laxity provided quantitative data for meta-analysis, finding significantly increased laxity during the ovulatory phase compared with the follicular phase. CONCLUSION The literature suggests an association between hormonal fluctuations and ACL injury. Recent studies have suggested that oral contraceptives may offer up to a 20% reduction in risk of injury. The literature on ACL injuries and the menstrual cycle has more than doubled over the past decade, permitting quantitative analysis for the first time. However, the overall strength of this evidence is low. Promising potential directions for future research include long-term observational studies with ongoing hormonal assays and large interventional trials of follicular suppression, including newer hormonal methods.
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Affiliation(s)
- Simone D Herzberg
- Seattle Pacific University, Seattle, Washington, USA.,Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Makalapua L Motu'apuaka
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Scientific Resource Center for the Evidence-Based Practice Center (EPC) Program, Portland VA Research Foundation, Portland, Oregon, USA
| | - William Lambert
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jacqueline Brady
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeanne-Marie Guise
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.,School of Public Health, Oregon Health & Science University, Portland, Oregon, USA.,Scientific Resource Center for the Evidence-Based Practice Center (EPC) Program, Portland VA Research Foundation, Portland, Oregon, USA.,Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.,Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
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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: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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10
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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: 31] [Impact Index Per Article: 3.9] [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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Fernández-Jaén T, López-Alcorocho JM, Rodriguez-Iñigo E, Castellán F, Hernández JC, Guillén-García P. The Importance of the Intercondylar Notch in Anterior Cruciate Ligament Tears. Orthop J Sports Med 2015; 3:2325967115597882. [PMID: 26535388 PMCID: PMC4622305 DOI: 10.1177/2325967115597882] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The factors associated with anterior cruciate ligament (ACL) tears are not completely clear. Some studies have shown that patients with a narrow intercondylar notch have a predisposition for ACL tears. Purpose To determine the relationship between the α angle and intercondylar notch width measurements and ACL tears. Study Design Case-control study; Level of evidence, 3. Methods A total of 530 patients (308 with ACL rupture, 222 with healthy ACLs) were included in this study. The α angle and intercondylar width were measured from magnetic resonance images (MRIs). Binary logistic regression analysis was performed to determine the influence of the variables on ACL status (normal or torn). Odds ratios (ORs) and their respective 95% CIs were also calculated. Results No significant differences in patient age and the affected knee were found between patients with normal or torn ACLs. The mean α angle was higher in patients with a torn ACL than in those with an intact one (57.5° ± 5.5° vs 56.2° ± 4.5°; P = .009). Intercondylar width was significantly lower in patients with a torn ACL than in those with an intact one (18.2 ± 3.1 vs 19.5 ± 3.6 mm; P < .001). A highly significant difference between men and women was found for mean intercondylar notch width (19.3 ± 3.3 vs 17.4 ± 3.1 mm; P < .001). In a logistic regression model, sex, intercondylar width, and α angle were statistically significant when adjusted for age. Conclusion Study results suggest that the ACL tears are associated with a narrow intercondylar notch and a high α angle, and that tears occur more frequently in men than in women. Clinical Relevance The model proposed in this study could be used by the physician in the medical office as a tool to identify the risk factors that may predispose a patient for a potential ACL tear.
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Affiliation(s)
- Tomás Fernández-Jaén
- Unidad de Investigación Biomédica, Clínica CEMTRO, Madrid, Spain. ; Cátedra de Traumatología del Deporte, Facultad de Medicina, Universidad Católica de Murcia, Murcia, Spain
| | | | | | - Fabián Castellán
- Unidad de Investigación Biomédica, Clínica CEMTRO, Madrid, Spain. ; Departamento de Traumatología, Hospital Universitario Reina Fabiola, Córdoba, Argentina
| | | | - Pedro Guillén-García
- Unidad de Investigación Biomédica, Clínica CEMTRO, Madrid, Spain. ; Cátedra de Traumatología del Deporte, Facultad de Medicina, Universidad Católica de Murcia, Murcia, Spain
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12
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Wolf MR, Murawski CD, van Diek FM, van Eck CF, Huang Y, Fu FH. Intercondylar notch dimensions and graft failure after single- and double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23:680-6. [PMID: 25380972 DOI: 10.1007/s00167-014-3414-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/29/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE The objective of this study was to evaluate the dimensions of the femoral intercondylar notch intraoperatively and to determine whether a small intercondylar notch increases the risk of graft failure after individualized anatomic single- or double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS A retrospective review of prospectively collected data was performed. One hundred and thirty-seven primary single- or double-bundle ACL reconstructions with at least 2-year follow-up were included in this study. Of these, 116 subjects had intraoperative notch measurements recorded. All operations were performed anatomically using a three-portal technique by the senior author. Intraoperative notch measurements (width at the base, middle, and top and height) were taken using a standard, commercially available arthroscopic ruler. Graft failure was defined as patient report of instability, pathologic laxity on clinical exam, or an MRI or arthroscopic diagnosis of rupture or absence of the ACL graft. RESULTS Graft failure at 2-year follow-up in the overall population was 13.9 % (19/137). Graft failure was reported to occur from contact or non-contact trauma, failure of the graft to incorporate, or hardware failure. The dimensions of the intercondylar notch and the graft type used did not influence the risk of graft failure. CONCLUSIONS Smaller intercondylar notch dimensions do not appear to be a risk factor for higher rates of graft failure after anatomic and individualized ACL reconstruction. Based on these data, the use of notchplasty is not supported in conjunction with individualized anatomic single- or double-bundle ACL reconstruction.
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Affiliation(s)
- Megan R Wolf
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 1101, Pittsburgh, PA, 15213, USA
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Whitney DC, Sturnick DR, Vacek PM, DeSarno MJ, Gardner-Morse M, Tourville TW, Smith HC, Slauterbeck JR, Johnson RJ, Shultz SJ, Hashemi J, Beynnon BD. 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 2014; 42:1796-805. [PMID: 24866891 PMCID: PMC6604056 DOI: 10.1177/0363546514534182] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The morphometric characteristics of the anterior cruciate ligament (ACL) and the femoral intercondylar notch within which it resides have been implicated as risk factors for injuries to this important stabilizer of the knee. Prior research has produced equivocal results with differing methodologies, and consequently, it is unclear how these characteristics affect the injury risk in male and female patients. HYPOTHESIS The morphometric characteristics of the ACL and femoral intercondylar notch are individually and independently associated with the risk of suffering a noncontact ACL injury, and these relationships are different in male and female patients. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Magnetic resonance imaging scans of the bilateral knees were obtained on 88 case-control pairs (27 male, 61 female) matched for age, sex, and participation on the same sports team. Patients had suffered a grade III, first-time, noncontact ACL tear. The femoral notch width at 4 locations, the thickness of the bony ridge at the anteromedial outlet of the femoral notch, the femoral notch volume, ACL volume, and ACL cross-sectional area were measured. RESULTS Multivariate analysis of combined data from male and female patients revealed that decreased ACL volume (odds ratio [OR], 0.829), decreased femoral notch width (OR, 0.700), and increased bony ridge thickness at the anteromedial outlet of the femoral notch (OR, 1.614) were significant independent predictors of an ACL injury. Separate analyses of male and female patients indicated that the femoral notch ridge may be more strongly associated with a risk in female patients, while ACL volume is more strongly associated with a risk in male patients. However, statistical analysis performed with an adjustment for body weight strengthened the association between ACL volume and the risk of injuries in female patients. CONCLUSION Morphometric features of both the ACL and femoral notch combine to influence the risk of suffering a noncontact ACL injury. When included together in a multivariate model that adjusts for body weight, the effects of the morphometric measurements are similar in male and female patients. If body weight is not taken into consideration, ACL volume is not associated with a risk in female patients.
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Affiliation(s)
- Darryl C. Whitney
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Daniel R. Sturnick
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Pamela M. Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Mike J. DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Mack Gardner-Morse
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Timothy W. Tourville
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Helen C. Smith
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - James R. Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Robert J. Johnson
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Sandra J. Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Javad Hashemi
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, Florida, USA
| | - Bruce D. Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont, USA.,Address correspondence to Bruce D. Beynnon, PhD, McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, 438A Robert T. Stafford Hall, 95 Carrigan Drive, Burlington, VT 05405, USA ( )
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