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Cernat EM, Neagu A, Betianu C, Manolescu LSC, Avram G, Pogarasteanu ME, Barbilian A. Balancing Anterior and Posterior Cruciate Ligaments in Adults. Cureus 2024; 16:e59683. [PMID: 38711864 PMCID: PMC11070883 DOI: 10.7759/cureus.59683] [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] [Accepted: 05/05/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) represent the central pivot of the knee. The balance between these two ligaments impacts the tibiofemoral biomechanics. Each structure is the opposite of the other in terms of anteroposterior translation and rotation. AIM The aim of this study was to find a correlation between the cross-sectional area of the ACL and PCL in adults. MATERIAL AND METHODS Magnetic resonance imaging (MRI) data analysis was conducted by a musculoskeletal radiologist using MRI planes tailored to the study's requirements. In all 62 studied patients, measurements were done according to the protocol. RESULTS The study observed three types of intercondylar notches: Type U was identified in 35% (22) of patients, type W in 27% (17), and type A in 37% (23). The median difference between the ACL and PCL areas was found to be statistically significant (p = 0.02). A significant difference in the area of the ACL was detected between Type A and Type U notches (p = 0.02), while no significant differences were found between Type A-W and Type W-U after post hoc corrections (p > 0.05). Additionally, no significant difference was observed in the mean area of the PCL across all three notch types (p = 0.1). In 68% of the cases, the ACL is no less than 60% of the PCL in area, and no more than 120%. The size of ACL and PCL in healthy individuals also depends on other factors like synergistic and antagonistic muscle activities, occupation, and the hip-knee-ankle axis. For example, if the PCL area is 0.79 cm² and the measured structure is round (during a reconstruction a hamstring graft is round), the diameter is 10 mm. A native ACL is, in 68% of the cases, no less than 7.7 mm, and no more than 10.9 mm. CONCLUSION The ACL-PCL size correlation helps in understanding the balance of the central pivot of the knee.
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Affiliation(s)
- Eduard M Cernat
- Department of Clinical Education, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Department of Orthopaedics, Doctor Carol Davila Central Military University Emergency Hospital, Bucharest, ROU
| | - Andrei Neagu
- Department of Radiology, Doctor Carol Davila Central Military University Emergency Hospital, Bucharest, ROU
| | - Cezar Betianu
- Department of Radiology, Doctor Carol Davila Central Military University Emergency Hospital, Bucharest, ROU
| | | | - George Avram
- Department of Clinical Education, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Department of Orthopaedics, Doctor Carol Davila Central Military University Emergency Hospital, Bucharest, ROU
| | - Mark-Edward Pogarasteanu
- Department of Clinical Education, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Department of Orthopaedics, Doctor Carol Davila Central Military University Emergency Hospital, Bucharest, ROU
| | - Adrian Barbilian
- Department of Clinical Education, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Department of Orthopaedics, Doctor Carol Davila Central Military University Emergency Hospital, Bucharest, ROU
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Nedaie S, Vivekanantha P, O'Hara K, Slawaska-Eng D, Cohen D, Abouali J, Hoshino Y, Nagai K, Johnson J, de Sa D. Decreased posterior tibial slope is a risk factor for primary posterior cruciate ligament rupture and posterior cruciate ligament reconstruction failure: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:167-180. [PMID: 38226729 DOI: 10.1002/ksa.12025] [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: 09/19/2023] [Revised: 11/11/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE To determine bony knee morphological factors associated with primary posterior cruciate ligament (PCL) rupture or PCL graft failure after PCL reconstruction. METHODS Three databases, namely MEDLINE, PubMed and EMBASE, were searched on 30th May 2023. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data such as receiver operating characteristic curve parameters, as well as p-values for comparisons of values between patients with PCL pathology and control patients, were recorded. RESULTS Nine studies comprising 1054 patients were included. Four studies reported that patients with PCL injury had flatter medial posterior tibial slopes (MTS) than controls, with mean values of 4.3 (range: 3.0-7.0) and 6.5 (range: 5.0-9.2) degrees, respectively. Two studies reported an MTS cutoff value ranging below 3.90-3.93° being a significant risk factor for primary PCL rupture or PCL graft failure. Two studies reported that shallow medial tibial depths were associated with primary PCL rupture, with mean values of 2.1 (range: 2.0-2.2) and 2.6 (range: 2.4-2.7) mm in PCL injury and control groups, respectively. Stenotic intercondylar notches and femoral condylar width were not consistently associated with PCL injuries. CONCLUSION Decreased MTS is associated with primary PCL rupture and graft failure after PCL reconstruction with values below 3.93° being considered as a significant risk factor. Less common risk factors include shallow medial tibial depth, while femoral condylar width and parameters with regards to the intercondylar notch, such as notch width, notch width index and intercondylar notch volume, demonstrated conflicting associations with primary or secondary PCL injuries. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Soroush Nedaie
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Kaylin O'Hara
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Dan Cohen
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Jihad Abouali
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Jansen Johnson
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
| | - Darren de Sa
- McMaster University Medical Center, Division of Orthopaedic Surgery, Hamilton, Ontario, Canada
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Huo Z, Hao K, Fan C, Li K, Li M, Wang F, Niu Y. The larger patellar tilt angle and lower intercondylar notch angle might increase posterior cruciate ligament injury risk: a retrospective comparative study. BMC Musculoskelet Disord 2023; 24:933. [PMID: 38041089 PMCID: PMC10691109 DOI: 10.1186/s12891-023-07054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Posterior cruciate ligament (PCL) injuries are common ligament injuries of the knee, and previous studies often focused on the associations between the morphology of the knee and PCL injuries. Studies on the correlation between PCL injuries and patellofemoral alignment are limited. METHODS This retrospective study included 92 patients with PCL injured and 92 patients with PCL intact. Measurement parameters were compared between the two groups, including patellar tilt angle, congruence angle, patellar height, hip-knee-ankle angle, lateral trochlear inclination, femoral condyle ratio, bicondylar width, intercondylar notch width and index, notch angle, trochlear facet asymmetry, and trochlear sulcus depth and angle. Independent risk factors associated with PCL injuries were identified by logistic regression analyses. RESULTS In the PCL injured group, the patellar tilt angle was significantly larger (13.19 ± 5.90° vs. 10.02 ± 4.95°, P = 0.04); the intercondylar notch angle was significantly lower (60.97 ± 7.83° vs. 67.01 ± 6.00°, P = 0.004); the medial and lateral femoral condyle ratio were significantly larger (0.63 ± 0.64 vs. 0.60 ± 0.56, P = 0.031; 0.65 ± 0.60 vs. 0.58 ± 0.53, P = 0.005) than in the PCL intact group. There were 11 patients with patellar dislocation in the PCL injured group, accounting for 12%. In these patients, the patellar height was higher (1.39 ± 0.17 vs. 1.09 ± 0.25, P = 0.009); the trochlear sulcus angle was larger (157.70 ± 8.7° vs. 141.80 ± 8.78°, P < 0.001); and the trochlear sulcus depth was shallower (3.10 ± 1.20mm vs. 5.11 ± 1.48mm, P = 0.003) than those in the patients without patellar dislocation. Multivariate analyses showed that patellar tilt angle (each increase 1 degree, OR = 1.14) and intercondylar notch angle (each increase 1 degree, OR = 0.90) were independent risk factors for PCL injuries. CONCLUSION The patients with PCL injuries had larger patellar tilt angles, lower intercondylar notch angles, and longer posterior femoral condyles than patients with PCL intact. The larger patellar tilt angle and lower intercondylar notch angle might be risk factors for PCL injuries.
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Affiliation(s)
- Zhenhui Huo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Kuo Hao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Chongyi Fan
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Kehan Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Ming Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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Dadoo S, Ozbek EA, Nukuto K, Runer A, Keeling LE, Grandberg C, Kuroda R, Zaffagnini S, Karlsson J, Hughes JD, Irrgang JJ, Musahl V. What it takes to have a high-grade pivot shift-focus on bony morphology. Knee Surg Sports Traumatol Arthrosc 2023; 31:4080-4089. [PMID: 37410122 DOI: 10.1007/s00167-023-07472-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Variations in femoral and tibial bony morphology have been associated with higher clinical grading and increased quantitative tibial translation, but not tibial acceleration, during the pivot shift test following anterior cruciate ligament (ACL) injury. The purpose of this study was to determine the impact of femoral and tibial bony morphology, including a measurement influenced by both parameters (the Lateral Tibiofemoral Articular Distance (LTAD)), on the degree of quantitative tibial acceleration during the pivot shift test and rates of future ACL injury. METHODS All patients who underwent primary ACL reconstruction from 2014 to 2019 by a senior orthopedic surgeon with available quantitative tibial acceleration data were retrospectively reviewed. All patients underwent a pivot shift examination under anesthesia with a triaxial accelerometer. Measurements of femoral and tibial bony morphology were performed by two fellowship-trained orthopedic surgeons using preoperative magnetic resonance imaging and lateral radiographs. RESULTS Fifty-one patients were included at a mean follow-up of 4.4 years. The mean quantitative tibial acceleration during the pivot shift was 13.8 m/s2 (range: 4.9-52.0 m/s2). A larger Posterior Condylar Offset Ratio (r = 0.30, p = 0.045), smaller medial-to-lateral width of the medial tibial plateau (r = - 0.29, p = 0.041), lateral tibial plateau (r = - 0.28, p = 0.042), and lateral femoral condyle (r = - 0.29, p = 0.037), and a decreased LTAD (r = - 0.53, p < 0.001) significantly correlated with increased tibial acceleration during the pivot shift. Linear regression analysis demonstrated an increase in tibial acceleration of 1.24 m/s2 for every 1 mm decrease in LTAD. Nine patients (17.6%) sustained ipsilateral graft rupture and 10 patients (19.6%) sustained contralateral ACL rupture. No morphologic measurements were associated with rates of future ACL injury. CONCLUSION Increased convexity and smaller bony morphology of the lateral femur and tibia were significantly associated with increased tibial acceleration during the pivot shift. Additionally, a measurement, termed the LTAD, was found to have the strongest association with increased tibial acceleration. Based on the results of this study, surgeons can utilize these measurements to preoperatively identify patients at risk of increased rotatory knee instability. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sahil Dadoo
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Emre Anil Ozbek
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Orthopedic Surgery and Traumatology, University of Ankara, Ankara, Turkey
| | - Koji Nukuto
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Armin Runer
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Laura E Keeling
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Camila Grandberg
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica, Istituto Orthopedico Rizzoli, Bologna, Italy
| | - Jon Karlsson
- Department for Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonathan D Hughes
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department for Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - James J Irrgang
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department for Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Li L, Li J, Zhou P, He Y, Li Y, Deng X, Jiang H, Liu J, Li Z. Decreased medial posterior tibial slope is associated with an increased risk of posterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 2023; 31:2966-2973. [PMID: 36622419 DOI: 10.1007/s00167-023-07308-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
PURPOSE It remains unclear whether there is an association between posterior cruciate ligament (PCL) rupture and the medial posterior tibial slope (MTS) or lateral posterior tibial slope (LTS). The present case-control study aimed to investigate a possible association between primary PCL rupture and MTS or LTS measured by magnetic resonance imaging (MRI). METHODS A retrospective case-control study was conducted. Patients with primary PCL ruptures but not with anterior cruciate ligament injuries, were 1:1 matched by age and sex to a control group with no evidence of knee ligament injuries. Knee MRI was used to measure the MTS and LTS. In addition, the receiver operating characteristic (ROC) analysis was performed to identify an optimal cut-off value of the MTS and/or LTS. RESULTS In total, 46 patients with PCL ruptures (32 males, 14 females) and 46 controls (32 males, 14 females) were included in this study. The MTS was significantly lower in the patients with PCL ruptures (3.0° ± 2.2°) than in the control group (5.1° ± 2.3°, p < 0.001). The mean LTS/MTS ratio was significantly higher in patients with PCL ruptures (2.6 ± 2.5) than in the control group (1.3 ± 1.3, p = 0.001). However, the LTS was not significantly different between patients with PCL ruptures and the controls (4.4° ± 2.3° vs. 5.3° ± 2.6°, n.s.). After the MTS was determined to be a significant predictor, the ROC analysis was performed. The ROC analysis revealed the most accurate MTS cut-off of < 3.9°, with a sensitivity of 76.1% and a specificity of 73.9%. CONCLUSION A decreased MTS and an increased LTS/MTS ratio are associated with an increased risk of primary PCL rupture. People with MTS < 3.9° are particularly at risk for PCL ruptures, and prevention and intervention programs for PCL ruptures should be developed and targeted towards them. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Lingzhi Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Jun Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Peng Zhou
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Yanwei He
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Yuan Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Xiangtian Deng
- Orthopedic Research Institution, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hao Jiang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China
| | - Juncai Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China.
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, Sichuan, People's Republic of China.
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Vivekanantha P, Diao YD, Cohen D, Abouali J, Hantouly A, de Sa D. Posterior tibial slope, notch width index and tibial tubercle to trochlear groove distance contribute to development of mucoid degeneration of the anterior cruciate ligament: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07435-7. [PMID: 37121934 DOI: 10.1007/s00167-023-07435-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE To determine what knee morphological factors are associated with the development of mucoid degeneration of the anterior cruciate ligament (ACL). METHODS Three databases MEDLINE, PubMed and EMBASE were searched from inception to January 29th, 2023 for literature outlining knee morphological factors that potentially lead to the development of mucoid degeneration of the ACL. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on receiver operating characteristic (ROC) curve parameters such as area under the curve (AUC), sensitivity and specificity, odds ratios, as well as p values for comparisons of values between mucoid degeneration of the ACL and control patients were recorded. The Methodological Index for Non-Randomized Studies (MINORS) score was used for all studies to perform a quality assessment of included studies. RESULTS A total of 7 studies comprising 1326 patients (1330 knees) were included in this review. Four studies reported a significant association between increasing posterior tibial slope angles and mucoid degeneration of the ACL presence, with one study specifying that posterolateral tibial slope had a greater association than posteromedial tibial slope. Two studies reported a significant association between lower notch width index values and mucoid degeneration of the ACL presence. One study found that the presence of trochlear dysplasia was correlated with mucoid degeneration of the ACL and two studies found that increased tibial tuberosity-trochlear groove distance (TT-TG) was associated with mucoid degeneration of the ACL. CONCLUSION Increased posterior tibial slope, decreased notch width index, and elevated TT-TG and trochlear dysplasia were associated with the presence of mucoid degeneration of the ACL. Information from this review can aid surgeons in understanding what morphological features predispose their patients to the development of mucoid degeneration of the ACL. Identifying what features predispose patients to mucoid degeneration of the ACL can help determine if regular screening or preventative strategies are necessary. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Yi David Diao
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main Street West, 4E14, Hamilton, ON, L8N 3Z5, Canada
| | - Jihad Abouali
- Department of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Ashraf Hantouly
- Department of Orthopaedic Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main Street West, 4E14, Hamilton, ON, L8N 3Z5, Canada.
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Intercondylar notch volume in patients with posterior cruciate ligament tears and tibial avulsion injuries: a study applying computed tomography. J Orthop Surg Res 2022; 17:560. [PMID: 36550563 PMCID: PMC9784257 DOI: 10.1186/s13018-022-03451-4] [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: 10/10/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Two relatively common forms of injury exist in the posterior cruciate ligament (PCL) after the onset of trauma: PCL tear and tibial avulsion fracture. The mechanism for the occurrence of these different forms of injury is not known. Herein, we aimed to investigate this mechanism by comparing the intercondylar notch parameters between patients with PCL tears and those with PCL avulsion fractures of the tibial insertion. METHODS Fifty-three patients with PCL tears (37 male, 16 female: median age of 37 years: range 18-54 years) and 46 patients with avulsion fractures of tibial insertion (33 male, 13 female: median age of 33 years: range 18-55 years) were included in this study. Three-dimensional computed tomography (CT) was applied to measure the intercondylar notch width index and intercondylar notch volume. The intercondylar notch volume was simulated as the truncated-pyramid shape. Measurements of the top and bottom areas of this model were conducted on the slice containing the most proximal (S1) and most distal (S2) levels of Blumensaat's line. Femoral condyle height (h) was defined as the vertical distance between two parallel planes, and the volume was calculated as h(S1 + S2 + √(S1S2))/3. The values of S1, S2, h, notch volume, the body mass index (BMI), intercondylar notch width (NW), femoral condylar width (FW) and notch width index (NWI) were compared among the PCL tear and avulsion-fracture groups. RESULTS The results show a significant difference in the S2 and normalized intercondylar notch volumes among patients with PCL tears and tibial avulsion injuries. Patients with PCL tears have smaller S2 and intercondylar notch volumes than those with tibial avulsion. There were no significant differences between the two groups in S1 or the 2D notch measurement parameters, such as the NW, FW and NWI. In addition, logistic regression analysis revealed notch volume and body mass index (BMI) as two significant independent predictors for PCL tears. CONCLUSION Decreased intercondylar notch volume and increased BMI are associated with an increased incidence of PCL tears. The occurrence of PCL tears and tibial avulsion injuries is influenced by the femoral intercondylar notch volume, and the measurement of the notch volume could be useful for identifying patients at risk for PCL tears.
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