LFCI and knee morphological parameters as a risk factor in anterior cruciate ligament tear on magnetic resonance imaging- A case control analysis.

Background: The anterior cruciate ligament is commonly injured and multiple risk factors have been studied. But there is paucity of articles considering predictive risk factors of femoral condyle morphology in south Indian population. This study aims to assess distal femoral condyle sphericity as a risk factor in anterior cruciate ligament injury and to correlate it with proximal tibia morphological risk factors. Materials and methods: This is a case control study including 80 patients with knee MRI aged between 18 and 60.They were grouped into cases (40) and controls (40). Cases being non-contact ACL injuries without multi ligamentous injuries and controls being MRI with ACL intact. Lateral femoral condyle index, posterior tibial slope, medial and lateral tibial depth were measured and compared. The risk factors were analysed with multiple logistic regression. Results: The lateral femoral condyle index had a mean value of 0.79 with standard deviation of ± 0.05 in cases group. Control group had a mean value of 0.803 with standard deviation of ± 0.05. Medial tibial slope in cases (8°) was lesser than in control group (7.6°). Lateral tibial slope was found to more among cases group (9.1°) than in control group (7.5°). Medial tibial depth had a mean of 4.07 mm among cases and 3.9 mm among control group. There was a moderate positive correlation between LFCI and Medial Tibial slope among cases that was statistically significant (P = 0.002). In addition, there was a weak negative correlation between LCFI and Medial Tibial Depth that was statistically significant. Conclusion: The lateral femoral condyle index was not found to be significant statistically among ACL injured patients. In our study we concluded that lateral tibial slope was more reliable risk factor in predicting ACL injury when compared to other parameters.

The Number of Patellar Dislocation Events Is Associated With Increased Chondral Damage of the Trochlea.

BACKGROUND: Patellofemoral instability is associated with chondral injuries to the patella, trochlea, and lateral femoral condyle. Although studies have demonstrated an association between patellar dislocations and chondral injuries, the influence of the number of dislocations on chondrosis is not established. PURPOSE: To elucidate the precise association between the number of patellar dislocation events and the severity of chondral injuries in a multicenter cohort study at the time of patellar stabilization procedures. STUDY DESIGN: Cross-sectional study; Level of evidence, 2. METHODS: A prospective multicenter cohort study (JUPITER [Justifying Patellar Instability Treatment by Early Results]) database was queried for cases of primary patellofemoral instability procedures from December 2016 to September 2022. Cartilage lesions were classified using the International Cartilage Repair Society (ICRS) classification system during an arthroscopic or open evaluation (direct visualization), with grades 2 to 4 considered abnormal. The number of dislocations was categorized as 1, 2-5, and >5. Categorical variables were compared with the chi-square test, and binary logistic regression was performed to identify predictors of the presence of chondral lesions. RESULTS: A total of 938 knees (mean age, 16.2 ± 3.8 years; 61.4% female) were included, with 580 (61.8%) demonstrating a chondral injury. The most affected region was the patella (n = 498 [53.1%]), followed by the lateral femoral condyle (n = 117 [12.5%]) and trochlea (n = 109 [11.6%]). There were no differences in the presence (P = .17) or grade (P = .63) of patellar lesions by the number of dislocations. Patients with >5 dislocations more frequently had trochlear chondral lesions (19.8%) compared with those with fewer dislocations (1, 7.6%; 2-5, 11.0%; P < .001). More dislocations were also associated with a higher proportion of ICRS grade 2 to 4 trochlear lesions (>5, 15.3%; 2-5, 10.0%; 1, 6.9%; P = .015). Combined patellar and trochlear lesions were also more common in those with >5 dislocations (P = .001). In multivariable regression, >5 dislocations was the only variable predictive of a trochlear lesion (odds ratio, 3.03 [95% CI, 1.65-5.58]; P < .001). CONCLUSION: This large prospective cohort study demonstrated that recurrent patellar dislocations can lead to more severe chondral damage in specific locations in the knee. More than 5 dislocations was associated with a >3-fold increase in the incidence and severity of trochlear chondral injuries. There were no differences in the presence or grade of patellar lesions by the number of dislocations. These findings should caution surgeons regarding prolonged nonoperative treatment.

The Chimeric LFC and DCIA Flap in Combined Mandibular and Condylar Head and Neck Reconstruction-A Case Series.

Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck. Methods: The chimeric flap was used in four patients with the following diagnoses: therapy-refractory osteomyelitis, extended recurrent odontogenic keratozyst, Goldenhar syndrome, and adenocarcinoma of the parotid gland. After a diagnostic workup, LFC and DCIA flaps were harvested in all patients and used in a sequential chimeric design for the reconstruction of the mandibular body and condylar head and neck. Results: Follow-up from at least 24 months up to 70 month after surgery showed a successful reconstruction in all four patients. The LFC provided a cartilaginous joint surface, allowing for a satisfactory masticatory function with a stable occlusion and unrestricted mouth opening and preserved or regained lateral and medial excursions in all patients. The DCIA allowed for a bony reconstruction anatomically resembling a non-atrophied mandibular body. No flap-related complications were observed. Conclusions: The sequential chimeric LFC and DCIA flap is an appropriate method for reconstructing up to half of the mandible and the condylar head and neck. It is suitable in cases where alloplastic joint replacement cannot be used or where other methods have failed. Due to the necessity of harvesting two flaps, the burden of care is increased, and a careful indication is required. The technique is reserved for maxillofacial surgeons who have already gained significant experience in the field of microsurgery.

Tibiofemoral bone configuration is not associated with hamstring muscle strength in male and female patients with ACL reconstruction.

PURPOSE: Previous evidence indicated that the tibiofemoral bone configuration might elevate the risk of an anterior cruciate ligament (ACL) injury. Furthermore, a low hamstring-to-quadriceps muscle ratio predisposes especially females to unfavourable knee kinematics. The primary objective of the present study was to investigate sex-specific associations between tibiofemoral bone geometry and isokinetic knee flexion torque in patients with primary ACL injury followed by ACL reconstruction. METHODS: N = 100 patients (72 = male, 28 = female, age = 31.3 ± 10.2, body mass index = 25.3 ± 3.6) with primary ACL rupture with isokinetic knee flexion torque assessments before and 6 months after ACL reconstruction surgery were analysed. Magnetic resonance imaging scans were analysed for medial posterior tibial slope (MPTS) and lateral posterior tibial slope, notch width index (NWI) and lateral femoral condyle index (LFCI). Additionally, isokinetic knee flexion torque (60°/s) and hamstring-quadriceps ratios were evaluated. Subsequently, functional parameters were correlated with imaging data for gender subgroups. RESULTS: The findings showed that presurgical isokinetic knee flexion torque was not associated with any marker of femoral or tibial bone geometry. Further, while significant differences were observed between female (0.883 ± 0.31 Nm/kg) and male (1.18 ± 0.35 Nm/kg) patients regarding preoperative normalized knee flexion torque (p < 0.001), no significant sex differences were found for percentage increases in normalized knee flexion torque from presurgery to postsurgery. Generally, female patients demonstrated significantly higher MPTS magnitudes (p < 0.05) and lower LFCI values (p < 0.05) compared to men. CONCLUSION: The present results demonstrated no association between tibial or femoral bone geometry and muscle strength of the hamstrings in patients with ACL reconstruction, indicating an important mismatch of muscular compensation to deviations in bone geometry. There were no sex-specific differences in tibiofemoral bone parameters. LEVEL OF EVIDENCE: Level III.

The relationship between lateral femoral condyle ratio measured by MRI and anterior cruciate ligament injury.

Background: Previous studies have shown that the lateral femoral condyle ratio (LFCR) measured by X-ray has a significant relationship with the anterior cruciate ligament (ACL) injury. However, few relevant studies have been performed on LFCR measured by magnetic resonance imaging (MRI). Purpose: (1) To evaluate the relationship between LFCR measured by MRI and ACL injury or rerupture. (2) To compare the LFCR measured by MRI with existing bony morphological risk factors and screen out the most predictive risk factors for primary ACL injury or rerupture. Study Design: Cohort study; Level of evidence, 3. Methods: Totally 147 patients who underwent knee arthroscopic surgery from 2015 to 2019 with minimum follow-up of 48 months were retrospectively evaluated. Patients were placed into three groups: 1) the control group of patients with simple meniscus tears without ligament injury; 2) the primary noncontact ACL injury group; 3) ACL rerupture group (ACL reconstruction failure). The LFCR measured by MRI and other previous known risk factors associated with MRI (notch width index, medial tibial slope, lateral tibial slope, medial tibial depth, lateral tibial height) were performed to evaluate their predictive value for ACL injury and rerupture. All the risk factors with p < 0.01 according to univariate analysis were included in the logistic regression models. Receiver operating characteristic (ROC) curves were analyzed for sensitivity, specificity, cut-off, and area under the curve (AUC). Z tests were used to compare the AUC values. Results: The LFCR measured by MRI was obviously higher in primary ACL injury group (0.628 ± 0.020) and in ACL rerupture group (0.625 ± 0.021) than that in the control group (0.593 ± 0.030). The best risk factor was the LFCR with a cut-off of 0.602 (AUC, 0.818; 95% CI, 0.748-0.878; sensitivity, 90%; specificity, 66%). When combined with lateral tibial slope (cutoff, 7°) and lateral tibial height (cutoff, 3.6 mm), the diagnostic performance was improved significantly (AUC, 0.896; 95% CI, 0.890-0.950; sensitivity, 87%; specificity, 80%). Conclusion: The increased LFCR measured by MRI was associated with a significantly higher risk for ACL injury or rerupture. The combination of LFCR, lateral tibial slope and lateral tibial height were the most predictive risk factors. This may help clinicians identify susceptible individuals and allow precision approaches for better prevention, treatment and management of this disease.

The Trochlear Paradox in Native Knees and Its Potential Impact on Total Knee Arthroplasty: An MRI-Based Correlation Study Investigating the Effect of Varying Posterior Femoral Condyle Angles on the Patellofemoral Joint.

BACKGROUND: Since the beginning of total knee arthroplasty, implant alignment has been a central point of discussion. As diverse as the discussed alignment theories are, as uniform is the implant design, which is supposed to be based on the "average knee." Steady upgrades in prosthesis design and modern alignment theories have achieved improvements. However, knee arthroplasty continues to be burdened by a significant percentage of dissatisfied patients. In current knee arthroplasty, femoral implant alignment is referenced by the dorsal and distal condylar axes. The patellofemoral joint variance is not sufficiently considered. Predominantly dorsal and distal referencing at the femoral condyle determines the postoperative shape of the anterior knee joint. The present study investigated a possible relationship between dorsal and distal joint parameters and the patellofemoral joint. METHODS: In this explorative retrospective monocentric study, MRI cross-sectional images of 100 native knee joints were evaluated. By determining parametric correlations according to Pearson, the study investigates whether the independent variables "posterior femoral condyle angle" and "lateral distal femoral angle" are related to "lateral trochlear inclination", "patella tilt", and "bisect offset". RESULTS: The posterior condylar angle significantly correlates with lateral trochlear inclination, patella tilt, and bisect offset. There is a positive correlation with patella tilt and bisect offset but a negative correlation with lateral trochlear inclination. The lateral distal femoral angle did not correlate with the studied parameters. CONCLUSION: The lateral trochlear inclination decreases with an increased posterior femoral condylar angle. The posterior referencing of the femoral component in total knee arthroplasty simultaneously establishes the shape of the anterior knee joint. Our results indicate that increasing posterior condyle angles significantly correlate with flattened lateral trochlear inclinations in native knees and suggest a systematic biomechanical conflict in total knee arthroplasty.

Increased lateral femoral condyle ratio measured by MRI is associated with higher risk of solitary meniscus injury.

Background: Past studies found that an increased lateral femoral condyle ratio is associated with anterior cruciate ligament injuries, but it is not clear if there is a link between MRI-measured lateral femoral condyle ratios and meniscal injuries. MRI provides a more accurate selection of measurement planes. Compared to X-rays, it further reduces data errors due to non-standard positions. Objective: To study the relationship between knee bone morphology and Solitary meniscal injuries by MRI. Methods: A total of 175 patients were included in this retrospective case-control study, including 54 cases of pure medial meniscus injury, 44 cases of pure lateral meniscus injury as the experimental group, and 77 control subjects. MRI images were used to measure the femoral notch width, femoral condylar width, femoral notch width index, lateral femoral condylar ratio (LFCR), posterior tibial slope, medial tibial plateau depth, and meniscus slope. In addition, carefully check for the presence of specific signs such as bone contusions and meniscal extrusions. Comparing the anatomical differences in multiple bone morphologies between the two groups, a stepwise forward multifactorial logistic analysis was used to identify the risk factors for Solitary meniscal injuries. Finally, ROC curves were used to determine the critical values and best predictors of risk factors. Results: MTS, LTS, and LFCR ended up as independent risk factors for meniscus injury. Among all risk factors, LFCR had the largest AUC of 0.781 (0.714-0.848) with a threshold of 72.75%. When combined with MTS (>3.63°), diagnostic performance improved with an AUC of 0.833 (0.774-0.892). Conclusion: Steep medial tibial plateau slope, steep lateral tibial plateau slope angle, and deep posterior lateral femoral condyles on MRI are independent risk factors for meniscal injuries. In patients with knee discomfort with the above imaging findings (X-ray, MRI), we should suspect and carefully evaluate the occurrence of meniscal injuries. It not only provides a theoretical basis to understand the mechanism of meniscus injury but also provides theoretical guidance for the prevention of meniscus injury and the development of intervention measures. Level of evidence III.

Tuberculosis of the Lateral Condyle of the Femur: A Case Report.

Tuberculosis in India has been a constant health issue. The revised national tuberculosis control program has suggested antitubercular drug regimens according to WHO guidelines for pulmonary and extrapulmonary tuberculosis. Here is an uncommon case of an adult presenting with a single lytic lesion of the lateral condyle of the femur; he had no history of primary foci of pulmonary tuberculosis and curettage of the lesion and histopathological examination of the bone tissue showed tubercular etiology. The patient, hence, was started on antitubercular drugs and at a six-month follow-up, resolution of the lesion was noticed.

What it takes to have a high-grade pivot shift-focus on bony morphology.

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.

Effect of Anterolateral Ligament Status and Inherent Knee Anatomy on Anterior Tibial Subluxation of the Lateral Compartment After Acute Anterior Cruciate Ligament Injury: A Cohort Study Based on MRI Analysis.

BACKGROUND: Anterior tibial subluxation (ATS) of the lateral compartment entails a pathological tibiofemoral alignment in knees with anterior cruciate ligament (ACL) injury. Causes of increased ATS after an acute ACL injury are not clear, but soft tissue abnormalities and bony variations of the knee are potential causes. PURPOSE: To determine whether increased ATS of the lateral compartment in knees with acute ACL injury is associated with (1) anterolateral ligament (ALL) status and (2) inherent anatomy of the lateral femoral condyle (LFC) and lateral tibial plateau (LTP). STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 337 patients with clinically diagnosed ACL injuries treated between September 2019 and August 2021 were retrospectively reviewed, and 119 patients with acute ACL injury were included. Of them, 79 patients with impaired ALL (ALL injury group) and 40 patients with intact ALL (ALL intact group) were identified based on magnetic resonance imaging (MRI). The ATS of the lateral compartment measured on MRI was compared between the 2 groups. The bony anatomy of knees, quantified by the LFC length, LFC height, LTP length, and LTP slope, was also evaluated on MRI and correlated with the ATS with partial correlation coefficients. Multivariate linear regression was used to identify the independent predictors of increased ATS. RESULTS: The ATS of the lateral compartment in the ALL injury group was significantly larger than that in the ALL intact group (6.3 mm vs 4.0 mm, respectively; P = .001). In all included patients, the presence of ALL injuries independently predicted a mean increase in ATS of 1.8 mm (P = .003). In the ALL injury group, ATS was significantly correlated with LFC length (r = 0.463; P < .001), LFC height (r = -0.415; P < .001), and LTP slope (r = 0.453; P < .001); further, a 1-mm increase in LFC length, 1-mm decrease in LFC height, and 1° increase in LTP slope independently predicted a mean increase in ATS of 0.7 mm (P < .001), 0.6 mm (P < .001), and 0.5 mm (P < .001), respectively. In the ALL intact group, there was no significant correlation between ATS and any bony parameter. CONCLUSION: An impaired ALL increased the ATS of the lateral compartment after acute ACL injuries. In patients with combined ALL injuries, a flatter LFC and a steeper LTP in the sagittal plane were predictors of a further increase in ATS.

Lateral Femoral Trochlea Flap Reconstruction of the Proximal Capitate: An Assessment of Congruity and Description of Technique.

PURPOSE: We examined morphologic similarities of the medial lateral femoral trochlea (MFT) and lateral femoral trochlea (LFT) osteochondral flaps for reconstruction of the proximal capitate. METHODS: Magnetic resonance imaging scans of the wrists and ipsilateral knees of 10 young healthy volunteers were obtained. Three morphologic parameters were investigated, comparing the MFT and LFT harvest sites to the capitate proximal pole. The correspondingly relevant surgical planes were compared. The coronal plane radius of curvature (ROC) of the capitate was compared with the sagittal planes of the MFT and LFT. The sagittal plane ROC of the capitate was compared to the axial planes of the MFT and LFT. The angular relationship between the dorsal cortical surface of the capitate and the proximal pole cartilage (proximal dorsal capitate pitch) was compared to the corresponding angles between the cortical bone and convex cartilage on the LFT and MFT. RESULTS: The average ratios of ROC for the coronal planes of the capitate to the MFT (0.61) and LFT (0.58) were similar. The average ratios of ROC for the sagittal planes of the capitate to the MFT (0.57) and LFT (0.86) were also similar. The proximal dorsal capitate pitch demonstrated greater similarity to the corresponding shape of the LFT (angular ratio, 1.01) than to that of the MFT (angular ratio, 0.74). CONCLUSIONS: The LFT and MFT demonstrate similar congruity to the proximal capitate in the sagittal and coronal planes of the wrist. The LFT dorsal pitch closely approximates the relationship of the proximal capitate pole to its dorsal cortical surface. CLINICAL RELEVANCE: In capitate fracture, fracture nonunion, or avascular necrosis, both the MFT and LFT demonstrate similarity to the proximal convex capitate morphology. The relationship between the cortical and chondral surfaces of the LFT is morphologically very similar to that of the proximal capitate.

Management of Lateral Femoral Condyle Non-union with Autogenous Bone Graft in CAS Total Knee Arthroplasty.

Introduction: Neglected distal femur fractures often present with significant uncontained bone defects of the lateral femoral condyle (LFC) leading to a valgus deformity and lateral compartment arthritis. Case Report: Bone defect can be managed with the help of autogenous bone graft harvested from a distal femur cut and shaped in the form of an augment. The objective of using bone graft along with the primary femur was to restore bone stock in a young patient and prevent the use of an augment with a revision femur and intramedullary rod. Conclusion: The use of computer navigation helped in getting accurate components and overall alignment thus facilitating compression at the bone graft site and early union.

Correlation Between Anatomic Landmarks and Bony Trough Position in Lateral Meniscal Allograft Transplant.

Background: Determining the rotational axis of the bony trough during lateral meniscal allograft transplant (MAT) is difficult. The use of anatomic landmarks may help a surgeon determine the rotational alignment of the graft during the procedure. Purpose: To investigate the association between the knee's anatomic landmarks and the position of the bony trough to prevent extrusion after lateral MAT. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Enrolled were 44 patients who underwent lateral MAT between July 2000 and February 2011. The patients' mean age at the time of surgery was 30.8 years. Extrusion was measured on magnetic resonance imaging (MRI) scans at a mean of 3.6 months postoperatively, and patients were divided into an extrusion group (n = 15) and a no-extrusion group (n = 29). Three coronal MRI scans from each patient were selected, each from the region at the level of the tibial tuberosity (TT), the anterior bony trough, and the posterior bony trough. We measured the distance between the center of the anterior bony trough and the center of the TT (the TT distance) and the distance between the center of the posterior bony trough and the medial border of the lateral femoral condyle (LFC) (the LFC distance). Results: The mean center of the anterior bony trough was in a more medial position relative to the center of the TT in the no-extrusion group (-2.9 ± 4.8 mm) compared with the extrusion group (1.3 ± 4.9 mm; P = .010). The mean center of the posterior bony trough was in a more medial position relative to the medial border of the LFC in the no-extrusion group (-1.7 ± 3.9 mm) compared with the extrusion group (1.0 ± 3.2 mm; P = .027). Both TT distance and LFC distance were significantly correlated with extrusion (P = .005 and .025, respectively). The cutoff value was -0.24 mm for the anterior bony trough and -0.58 mm for the posterior bony trough (negative values indicate that the trough was medial to the respective landmarks). Conclusion: To prevent extrusion of the allograft, the center of the anterior bony trough needs to be aligned with the center of the TT, and the center of the posterior bony trough needs to be aligned with the medial border of the LFC.

Valgus knee deformity due to nonunion of lateral Hoffa fracture: A case report.

Hoffa fractures are rare intra-articular injuries, and nonunion of Hoffa fractures is rarer. We report the case of an adult male with a nonunion of a Hoffa fracture by open reduction and internal fixation in which the lateral meniscus tear was treated by an arthroscopic surgery. A healthy 38-year-old man who had a history of untreated trauma to the left knee in a motorcycle accident 11 years ago presented to our hospital with the complaint of chronic left knee pain for 5 years. The patient had an obvious valgus knee with 0°-140° of motion, and radiographs revealed the nonunion of the left lateral Hoffa fracture (Letenneur type-III). Routine arthroscopic evaluation and a lateral meniscus posterior tear repair using all inside device were performed. The knee joint was exposed using a lateral para patella approach. The fracture was fixed with three 4.5-mm headless screws and distal femoral locking plates. Mobilization was started from the first operative day. Full weight bearing was allowed 8 weeks postoperatively. At the 1-year follow up, the X-ray showed healing of the nonunion site with no displacement of the Hoffa fracture. The knee range of motion, lower limb alignment, and clinical outcome were also improved. Nonunion of the Hoffa fracture should be treated by an internal fixation despite the chronicity.

Increased lateral femoral condyle ratio measured by MRI is associated with higher risk of noncontact anterior cruciate ligament injury.

BACKGROUND: Studies have shown a significant association between the radiographically measured lateral femoral condyle ratio (LFCR) and anterior cruciate ligament (ACL) injury. However, it is unclear whether LFCR measured by magnetic resonance imaging (MRI) is associated with a higher risk of noncontact ACL injury. OBJECTIVE: To investigate the effect of LFCR on the risk of noncontact ACL injury by MRI. 2 to investigate the association of LFCR measured by MRI with multiple bone morphological risk factors and evaluate the most sensitive risk predictors of noncontact ACL injury. METHODS: A total of 116 patients, including 58 subjects with noncontact ACL injury and 58 age-matched and sex-matched controls with only meniscus injury, were included in this retrospective case-control study. LFCR, lateral tibial slope (LTS), lateral tibial height (LTH), medial tibial slope (MTS), and medial tibial depth (MTD) were measured on MRI. The differences in each index between the two groups were compared, and risk factors were screened by single-factor logistic regression analysis. Indicators with P values < 0.1 were included in the logistic regression equation. The critical values and areas under the curve (AUCs) of independent risk factors were determined by receiver operating characteristic (ROC) curve analysis. Finally, the diagnostic performance of each risk factor was evaluated by the Z-test. RESULTS: A total of 116 patients who met the inclusion criteria were included in the final analysis (58 cases in the noncontact ACL injury group and 58 cases in the control group). Patients with noncontact ACL injury had a higher femoral LFCR (0.64 ± 0.03) than patients with isolated meniscus tears. Among all the risk factors for ACL injury, the AUC for LFCR was the largest, at 0.81 (95% CI, 0.73-0.88), and when the critical value was 0.61, the sensitivity and specificity for the diagnosis of ACL injury were 0.79 and 0.67, respectively. When combined with LTH (> 2.35 mm), the diagnostic performance was improved. The AUC was 0.85 (95% CI, 0.78-0.92), the sensitivity was 0.83, and the specificity was 0.76. CONCLUSION: This study shows that an increased LFCR is related to an increased risk of noncontact ACL injury as determined by MRI. LFCR and LTH are sensitive risk factors for noncontact ACL injury and may help clinicians identify individuals prone to ACL injury, allowing prevention and intervention measures to be applied.

The Relationship Between Lateral Femoral Condyle Index and Noncontact Anterior Cruciate Ligament Rupture.

PURPOSE: The purpose of this study was to examine the relationship between distal femoral morphology and noncontact anterior cruciate ligament (ACL) rupture and the differences between digital X-ray imaging systems (DR) and magnetic resonance imaging (MRI) to evaluate distal femoral morphology. METHODS: A retrospective case-control study was performed on 120 patients. Two age- and sex-matched cohorts (each n = 60) were analyzed: primary ACL ruptures and a control group consisting of isolated meniscal tears. The lateral femoral condyle index (LFCI) was measured by DR and by MRI to quantify femoral sphericity. Differences among two groups were compared, and diagnostic performance of the risk factors was assessed. In addition, differences between DR and MRI to evaluate LFCI were examined. RESULTS: The LFCI by MRI was smaller in the knees with primary ACL rupture (median, 0.71; range, 0.62-0.78) than that of the control group (median, 0.77; range, 0.66-0.85) (p < 0.01). The LFCI was also significantly smaller in the knees with primary ACL rupture (median, 0.72; range, 0.63-0.77) than that of the control group (median, 0.79; range, 0.65-0.84) (p < 0.01) by DR. A cutoff of 0.74 of MRI yielded a sensitivity of 77% and a specificity of 78% to predict an ACL rupture, and of 0.75 of DR yield a sensitivity of 87% and a specificity of 77% to predict an ACL rupture. CONCLUSION: This study showed that a decreased LFCI is associated with an ACL rupture, and both DR and MRI measurements can effectively predict the risk of ACL rupture. This helps expand the scope of the application of the LFCI and helps clinicians identify susceptible individuals who may benefit from targeted ACL rupture prevention counseling and intervention.

The Lateral Femoral Condyle Index Is Not a Risk Factor for Primary Noncontact Anterior Cruciate Ligament Injury.

BACKGROUND: The lateral femoral condyle index (LFCI)-a recently developed measure of the sphericity of the lateral femoral condyle-was reported to be a risk factor for anterior cruciate ligament (ACL) injury. However, issues have been raised regarding how the index was measured and regarding the patient group and the knee in which it was measured. PURPOSE: To investigate the association between the LFCI and the risk of sustaining a primary, noncontact ACL injury, and to examine whether this association was moderated by the posterior-inferior-directed slope of the lateral tibial plateau. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A secondary analysis was conducted of deidentified magnetic resonance images of the uninjured knees of 86 athletes with ACL injury and the corresponding knees of 86 control athletes, matched for sports team, sex, and age. From those images, we measured the LFCI and the posterior-inferior-directed slope of the middle region articular cartilage surface of the tibial plateau's lateral compartment. Conditional logistic regressions were performed to determine whether the LFCI was significantly associated with ACL injury risk and whether the lateral tibial compartment middle cartilage slope moderated this association. Data were analyzed for female and male participants separately as well as for both groups combined. RESULTS: The LFCI was not found to be significantly associated with experiencing a primary, noncontact ACL injury for all analyses. The lateral tibial slope measure was not found to moderate the association between the LFCI and ACL injury. A conditional logistic regression analysis using the LFCI data of the injured knees, instead of the uninjured knees, of the participants with ACL injury revealed that the LFCI was significantly associated with ACL injury. CONCLUSION: In this population of athletically active female and male participants, the LFCI was not found to be a risk factor for noncontact ACL injury, regardless of the geometric features of the lateral tibial slope.

Good medium-term functional results in reconstruction of lateral femoral condyle osteochondral lesions.

INTRODUCTION: Results of autologous osteochondral graft (mosaicplasty) are well-reported for the medial femoral condyle but much less for the lateral femoral condyle. The main aim of the present study was to assess results specifically for lateral condyle reconstruction. The secondary objective was to compare results according to the two main etiologies: osteochondritis dissecans (OCD) and osteochondral fracture (OCF). HYPOTHESIS: The study hypothesis was that medium-term functional and radiological results of lateral femoral condyle autologous osteochondral graft are good. MATERIAL AND METHODS: A single-center retrospective continuous study included 24 patients with symptomatic focal lateral femoral condyle osteochondral lesion treated by osteochondral autograft, at a minimum 24 months' follow-up. Mosaicplasty was performed for lesions <200 mm2, with associated fixation for lesions >200 mm2 with viable osteochondral fragments. IKDC, Lysholm and KOOS functional scores and pain on visual analog scale (VAS) were collected at last follow-up. Progression toward osteoarthritis was assessed on comparative X-ray. RESULTS: Twenty patients were analyzed (11 OCD, 9 OCF) at a mean of 66.4±44 months. Mean pain on VAS was 1.8±2 out of 10. Mean subjective IKDC, Lysholm and global KOOS scores were respectively 68.1±26, 76.5±22 and 73.9±21. Two patients showed Ahlbäck grade 2 lateral femorotibial osteoarthritis. Functional results were comparable between OCD and OCF. CONCLUSION: Reconstruction of lateral femoral condyle osteochondral lesion by osteochondral autograft gave good medium-term functional results, whatever the etiology. Longer-term studies are needed to assess progression toward osteoarthritis and functional deterioration over time. LEVEL OF EVIDENCE: IV; retrospective study.

Arthroscopy Assisted Reduction and Internal Fixation of a Lateral Femoral Condyle Fracture after Anterior Cruciate Ligament Reconstruction with Graft Salvage and Reinforced Suspensory Femoral fixation - A Case Report.

INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction using hamstring tendon graft is a commonly performed orthopedic surgery. Lateral femoral condyle fracture through the femoral tunnel is a rare complication following ACL reconstruction. These cases are reported to be managed in two stages, fracture fixation by open reduction and internal fixation with bone grafting of the femoral tunnel, followed by revision ACL reconstruction after the fracture union. CASE REPORT: A 41-year-old male Kabaddi player underwent right knee arthroscopic ACL reconstruction following an ACL tear in January 2021, sustained a road traffic accident 7 weeks later and developed a lateral femoral condyle fracture. The graft was intact and trapped into the fracture site making fracture reduction difficult. The graft was lax due to the fixed loop button being trapped in the fracture. The patient was treated in a single stage by arthroscopy assisted fracture reduction and fixation with ACL graft salvage and reinforced suspensory femoral graft fixation to plate suspensory fixation. CONCLUSION: This case is a rare presentation of lateral condyle fracture after ACL reconstruction and both the issues are managed in a single stage with the help of detailed surgical planning, using utmost arthroscopy skills and keeping all the options of fixation devices ready on the table during the surgery.

An adult case of spontaneous healing of concurrent osteochondritis dissecans of the lateral femoral condyle after saucerization with meniscal repair for discoid lateral meniscus: A case report.

BACKGROUND: The treatment strategy for osteochondritis dissecans (OCD) with discoid lateral meniscus (DLM) in adults remains unclear. CASE PRESENTATION: A 22-year-old man presented with left knee pain after spraining his knee. Physical examination revealed lateral joint line tenderness and a positive McMurray test. Radiographic imaging showed OCD of the lateral femoral condyle classified as stage 3 on Brückl's classification. Magnetic resonance imaging showed complete DLM with anterocentral shift based on Ahn's classification and an OCD of 11 mm × 8 mm, grade 2 based on Nelson's classification. On computed tomography (CT), a demarcated fragment was observed in the lesion. Based on these findings, saucerization with meniscal repair was performed for unstable DLM. The OCD lesion presented with softening without any fissure and was diagnosed as grade 1. No surgical procedure was added. One year after surgery, the union of the fragment was confirmed on radiograph and CT. At the final follow-up five years after surgery, the Lysholm score had improved from 58 to 100 points. CONCLUSIONS: We experienced an adult case of stable OCD with concurrent DLM that achieved spontaneous healing after undergoing reshaping surgery for DLM, mimicking normal meniscal morphology, without additional treatment for the stable OCD lesion.