Description of new sign of integral (∫) for rotational deformity of distal femur.

PURPOSE: Femur shaft fractures commonly occur due to high velocity trauma and most of them are fixed with nailing. Malrotation is common after fixation. A rotational malalignment more than 30° is a deformity which requires correction. Various techniques described for rotational deformities are: the 'cable techniques' for the determination of varus-valgus malalignment; the 'hyperextension test', 'radiographic recurvatum sign', 'tibial plateau sign', and 'meterstick technique' for length analysis; and the 'hip rotation test', 'lesser trochanter shape sign', 'cortical step sign', and 'diameter difference sign' for rotational analysis. We describe integration sign at the medial or lateral aspect of notch of femur in fixed internal or external rotation due to condensation of trabeculae. METHODS: This is a prospective observational study. Informed consent was taken, and this study was approved by institutional review board. C arm imaging study of 50 knees was done at our institution in which rotational profile of distal femur was analyzed In 3 different views -AP , Internal and external rotation views. The rotation views were taken sequentially and each observer was asked to identify the sign at its appearance and at rotation when it was best seen. All the observers were asked to draw the sign on linear line diagram of distal femur. The data was analysed statistically. RESULTS: Sign of integral (∫) for rotational deformity was seen at Mean external rotation of  22±1.71 with a range of 19 degree to 25 degree and  Mean internal rotation of 15.78±1.21 with a range of 14 degree to 18 degree. CONCLUSION: The integration sign can be used as intraoperative C arm sign to understand the rotational deformity of distal fragment of femur. This helps the surgeon to understand the alignment and revise if needed intraoperatively. If combined with position of lesser trochanter, this will give alignment for both proximal as well as distal fragment of femur.

Magnetic Resonance Imaging-Based Morphometric Analyses of the Bicruciate Injury of the Knee: Is There a Clue in the Distal Femur?

BACKGROUND: The morphology of the distal femur's intercondylar notch has been implicated in the susceptibility to and severity of cruciate ligament injuries. While previous research has primarily focused on isolated anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injuries, the relationship between notch morphology and combined cruciate injuries remains less understood. OBJECTIVE: This study aimed to explore the association between femoral notch morphology and the severity of combined cruciate ligament injuries in adult males. METHODS: In this retrospective cohort study, MRI scans from 118 adult male participants with and without knee dislocations (60 cases with Schenk classification Type II or higher knee dislocations and 58 controls) were analyzed. The study period ranged from 2015 to 2023. Femoral notch width, notch width index (NWI), and notch shape (U shape, A shape) were assessed using a Philips Multiva 1.5 Tesla system (Philips, Amsterdam, Netherlands). The statistical significance of differences in measurements between cases and controls was evaluated using independent sample t-tests performed with IBM SPSS Statistics, version 26 (IBM Corp., Armonk, NY). RESULTS: The case group exhibited a significantly smaller mean femoral notch width (15.88 mm ± 2.7 mm) and NWI (0.238 ± 0.58) compared to the control group (notch width 18.29 mm ± 3.4 mm, NWI 0.25 ± 0.31), with p-values of 0.004 for both measurements. The notch shape was predominantly A-shaped in the case group (n = 49) as opposed to U-shaped in the control group (n = 41). CONCLUSIONS: The study identifies a significant association between reduced femoral notch dimensions and the severity of complex cruciate ligament injuries. These findings support the notion that specific femoral notch morphologies may predispose individuals to more severe ligamentous injuries.

Tibial spine volume is smaller in ACL-injured athletes compared to healthy athletes.

PURPOSE: The aim of this study was to investigate whether the whole tibial spine volume and femoral intercondylar notch volume are risk factors for anterior cruciate ligament (ACL) injury. The hypothesis was that the whole tibial spine volume and femoral notch volume would be smaller in athletes who sustained ACL injury than in athletes with no history of ACL injury. METHODS: Computed tomography scans of both knees were acquired and three-dimensional bone models were created using Mimics to measure whole tibial spine volume and femoral notch volume. Tibial spine volume, femoral notch volume and each of these volumes normalised by tibial plateau area were compared between the ACL-injured and the ACL-intact group. RESULTS: Fifty-one athletes undergoing unilateral anatomical ACL reconstruction (17 female, 34 male: average age 22.0 ± 7.5) and 19 healthy collegiate athletes with no previous knee injury (eight female, 11 male: average age 20.1 ± 1.3) were included in this study. The whole tibial spine volume in the ACL-injured group (2.1 ± 0.5 cm3) was 20.7% smaller than in the ACL-intact group (2.7 ± 0.7 cm3) (p = 0.005). No differences were observed between the femoral notch volume in the ACL-injured group (9.5 ± 2.1 cm3) and the ACL-intact group (8.7 ± 2.7 cm3) (n.s.). CONCLUSIONS: The main finding of this study was that the whole tibial spine volume of the ACL-injured group was smaller than the ACL-intact group. A small tibial spine volume can be added to the list of anatomical risk factors that may predispose athletes to ACL injury. LEVEL OF EVIDENCE: Level Ⅲ.

Morphological analysis of patellofemoral joint in haemophilic arthropathy: A case-control study.

INTRODUCTION: Knees affected by haemophilic arthropathy exhibit distinct differences in both bone morphology and soft tissue behaviour. This study aims to analyse the morphological characteristics of the distal femur and patellofemoral joint in patients with haemophilia in comparison to normal healthy population. MATERIAL AND METHODS: Study was conducted as pair-matched case-control study with 43 individuals in both the haemophilia group and the control group. Patellar luxation, patellar tilt (PT), length of the patella in both axis (pAP, pML), depth and angle of trochlear sulcus (SD, SA), lateral trochlear inclination (LTI), medial and lateral femoral facet length (mFL, LFL), intercondylar depth (ID), transepicondylar axis (TEA) and lateral condyle length (LCL) were assessed on knee MRI. Correlation between Pettersson score and measured variables were also analysed. RESULTS: PT was medial sided in 10 (23.2%) cases in haemophilic group. Mean values of pAP, pML, PT were significantly lower in haemophilia group (p < .001, p: .007, p = .001 respectively). There were no significant changes in SA (p = .628), SD (p = .340), LTI (p = .685), LFL (p = .241) and MFC-LFC (p = .770) whilst mFL was significantly longer in haemophilia group (p = .009). ID (p < .001), TEA (p = .007) and LCL (p = .001) were all shorter in haemophilia group. Pettersson score was inversely correlated with pAP, pML, ID, TEA, LCL, pML/SA and ID/LCL. CONCLUSION: Morphological changes in haemophilic arthropathy involve a smaller and medially-tilted patella, narrowed lateral condyle and transepicondylar axis, combined with reduced intercondylar depth. These alterations must keep in mind especially in pre- and intraoperative assessments for arthroplasty procedures.

Could medial femoral notching be a marker in posterolateral corner injuries?

INTRODUCTION: Posterolateral corner (PLC) injuries constitute 16 % of all knee ligament injuries and are often seen with other ligamentous injuries. PLC injuries can be overlooked. If left untreated, other ligamentous reconstructions are at risk, residual laxity may occur, and early osteoarthritis may result. MATERIALS AND METHODS: Patients diagnosed with PLC injury and who underwent surgical treatment between November 2018 and November 2022 were retrospectively analyzed. Two groups were formed 44 PLC patients with a concomitant ligament injury and 50 patients with an isolated ACL injury (control group). Preoperative MRI findings and arthroscopic surgery findings of the patients were evaluated. Medial femoral condyle notching sign (MFNS) and lateral femoral condyle notching sign (LFNS) data were obtained from preoperative MRI sections. If the lesion depth was less than 1.5 mm, it was not considered a notching sign. RESULTS: In group 1, there were 44 patients with PLC injuries accompanied by other ligamentous injuries. In group 2, there were 50 patients with isolated ACL injuries not accompanied by other ligamentous injuries. Medial femoral notching sign (MFNS) was higher in Group 1 (p < 0.00001). The lateral femoral notching sign (LFNS) was higher in Group 2 (p:0.023). CONCLUSION: PLC injuries are difficult to diagnose. MFNS is a finding that may facilitate diagnosis in PLC injuries.

[Long-term outcomes of lateral femoral notch after early anterior cruciate ligament reconstruction].

OBJECTIVE: To investigate the outcome of lateral femoral notch (LFN) after early anterior cruciate ligament (ACL) reconstruction and evaluate the recovery of knee joint function after the operation. METHODS: The clinical data of 32 patients who underwent early ACL reconstruction from December 2015 to December 2019 were retrospectively analyzed. The study included 18 males and 14 females, aged 16 to 54 years old, with an average age of (25.39±2.82) years. The body mass index (BMI) of the patients ranged from 20 to 30 kg/cm2, with an average of (26.15±3.09) kg/cm2. Among them, 6 cases were caused by traffic accidents, 19 by exercise, and 7 by the crush of heavy objects. MRI of all patients showed LFN depth was more than 1.5 mm after injury, and no intervention for LFN was performed during surgery. Preoperative and postoperative depth, area, and volume of LFN defects were observed by MRI data. International Cartilage Repair Society (ICRS) score, Lysholm score, Tegner activity levels, and knee injury and osteoarthritis outcome score (KOOS) were analyzed before and after the operation. RESULTS: All patients were followed up from 2 to 6 years with an average of (3.28±1.12) years. There was no significant difference in the defect depth of LFN from (2.31±0.67) mm before the operation to (2.53±0.50) mm at follow-up (P=0.136). The defect area of LFN was decreased from (207.55±81.01)mm2 to (171.36±52.69)mm2 (P=0.038), and the defect volume of LFN was decreased from (426.32±176.54) mm3 to (340.86±151.54)mm3 (P=0.042). The ICRS score increased from (1.51±0.34) to (2.92±0.33) (P<0.001), the Lysholm score increased from (35.37±10.54) to (94.46±8.45) (P<0.001), and the Tegner motor score increased from (3.45±0.94) to (7.56±1.28), which was significantly higher than that of the preoperative data (P<0.001). The KOOS score of the final follow-up was 90.42±16.35. CONCLUSION: With the increase of recovery time after anterior cruciate ligament reconstruction, the defect area and volume of LFN decreased gradually, but the defect depth remained unchanged. The knee joint function of the patients significantly improved. The cartilage of the LFN defect improved, but the repair effect was not good.

Diagnostic value of the lateral femoral notch sign and kissing contusion in patients with anterior cruciate ligament injuries: a case-control study.

INTRODUCTION: The lateral femoral notch sign (LFNS) and the kissing contusion (KC) are two indirect signs of anterior cruciate ligament (ACL) injuries. They can be used to diagnose ACL injuries. MATERIALS AND METHODS: A total of 1000 patients were enrolled in this study, including 500 patients with ACL injuries who assigned to experimental group and 500 patients with meniscal tear (MT) who allocated to control group. All the patients underwent magnetic resonance imaging (MRI) preoperatively, and the diagnosis was confirmed with the aid of arthroscopy. The depth of LFNS and the presence of KC were determined on MRI findings. The relationship and characteristics between these two indicators was explored. RESULTS: The notch depth of lateral femoral condyle in the experimental group (0.99 ± 0.56 mm) was significantly greater than that in the control group (0.49 ± 0.28 mm) (P < 0.05). The positive rate of KC in the experimental group (183/500) was markedly higher than that in the control group (3/500) (P < 0.05). The values of notch depth in patients who had ACL rupture concomitant lateral MT injuries and medial collateral ligament (MCL) injuries were 1.12 ± 0.64 and 1.23 ± 0.74 mm, respectively, which were significantly higher than those in patients with only ACL injury (0.89 ± 0.49 mm) (P < 0.05). It also was revealed that when the optimal cut-off point of LFNS was 0.72 mm (area under the curve (AUC) = 81%), the values of specificity and sensitivity were 67% and 84%, respectively. For KC, the corresponding values were 36.6% and 99.4%, respectively. The diagnostic outcome of LFNS was not in agreement with that of KC, as there was a poor coincidence according to the Kappa coefficient (Kappa = 0.155 < 0.4, P = 0.035). CONCLUSION: The LFNS and KC have strong clinical significance in the diagnosis of ACL injuries. A deeper notch often indicates a more complex knee injury. Notch depth equal to 0.72 mm can be basically considered as the optimal cut-off point for LFNS in statistics.

The lateral femoral notch sign decreases in paediatric patients following anterior cruciate ligament reconstruction.

INTRODUCTION: Anterior cruciate ligament (ACL) ruptures are common amongst paediatric patients, especially those participating in competitive sports. While magnetic resonance imaging (MRI) is typically used to confirm the diagnosis, certain radiologic findings can be indicative of an ACL tear, including a lateral femoral notch sign (LFNS) > 1.5 mm (mm). No study has focussed on understanding the resolution pattern of the LFNS in paediatric patients following ACL reconstruction (ACLR). The aim of this study is to determine whether the depth of the LFNS regresses following ACLR. The authors hypothesize that following ACLR, the LFNS will resolve. METHODS: All patients who were treated for acute ACL rupture by one of two paediatric orthopaedic surgeons between 2015 and 2020 were collected; 321 patients with the age of 5-18 were collected. Patients were excluded if they underwent previous ipsilateral knee surgeries and if they did not have pre-operative knee radiographs; 274 patients met inclusion criteria. LFNS was measured on pre-operative (PreOp) and most recent post-operative (PostOp) radiographs. A comparison cohort of patients with an LFNS <1.5 mm matched by age within 1.5 years, sex, and laterality was also collected. The median difference was calculated by taking the difference between PreOp LFNS and PostOp LFNS of each participant and finding the median of those values. RESULTS: A total of 274 pre-operative radiographs were analysed for an LFNS depth >1.5 mm. Seventeen radiographs met these criteria with a median age of 16.3 years and a median depth of 1.70 mm. Of the 17 radiographs, 8 (47.1%) of participants were skeletally immature. The median LFNS depth at most recent follow-up and median percent decrease were 1.50 mm and 28%, respectively. Only 11.8% of patients demonstrated no change in LFNS depth from PreOp to PostOp imaging. Wilcoxon signed-rank test indicated that the PreOp LFNS was significantly greater than the PostOp LFNS (p < 0.001). Mann-Whitney U tests with cases and the comparison cohort demonstrated no difference in the percent decrease (p = 0.106). CONCLUSION: This study sought to understand the resolution of the LFNS depth following initial ACL rupture. At a median of 7.67 months following ACLR, the LFNS depth decreased significantly by 0.60 mm. These findings suggest that following ACL rupture, the paediatric LFNS has the potential to resolve. Future studies should aim to further assess the resolution pattern of the LFNS with advanced imaging, such as MRI.

Lateral femoral notch sign and posterolateral tibial plateau fractures and their associated injuries in the setting of an anterior cruciate ligament rupture.

INTRODUCTION: ACL injury is one of the most common injuries of the knee joint in sports. As accompanying osseous injuries of the ACL rupture a femoral impression the so-called lateral femoral notch sign and a posterolateral fracture of the tibial plateau are described. However, frequency, concomitant ligament injuries and when and how to treat these combined injuries are not clear. There is still a lack of understanding with which ligamentous concomitant injuries besides the anterior cruciate ligament injury these bony injuries are associated. MATERIALS AND METHODS: One hundred fifteen MRI scans with proven anterior cruciate ligament rupture performed at our center were retrospectively evaluated for the presence of a meniscus, collateral ligament injury, a femoral impression, or a posterolateral impression fracture. Femoral impressions were described according to their local appearance and posterolateral tibial plateau fractures were described using the classification of Menzdorf et al. RESULTS: In 29 cases a significant impression in the lateral femoral condyle was detected. There was a significantly increased number of lateral meniscal (41.4% vs. 18.6% p = 0.023) and medial ligament (41.4% vs. 22.1%; p = 0.040) injuries in the group with a lateral femoral notch sign. 104 patients showed a posterolateral bone bruise or fracture of the tibial plateau. Seven of these required an intervention according to Menzdorf et al. In the group of anterior cruciate ligament injuries with posterolateral tibial plateau fracture significantly more lateral meniscus injuries were seen (p = 0.039). CONCLUSION: In the preoperative planning of ACL rupture accompanied with a positive femoral notch sign, attention should be paid to possible medial collateral ligament and lateral meniscus injuries. As these are more likely to occur together. A posterolateral impression fracture of the tibial plateau is associated with an increased likelihood of the presence of a lateral meniscal injury. This must be considered in surgical therapy and planning and may be the indication for necessary early surgical treatment.

[Research progress of lateral femoral notch sign in diagnosis of anterior cruciate ligament rupture].

OBJECTIVE: To summarize the relationship between lateral femoral notch sign (LFNS) and anterior cruciate ligament (ACL) rupture. METHODS: The relevant literature of LFNS at home and abroad in recent years was retrospectively reviewed, and its mechanism, diagnostic criteria and influencing factors in diagnosis of ACL rupture were summarized and analyzed. RESULTS: The LFNS is associated with rotational stability of the knee. As an indirect sign of ACL rupture, the LFNS has high clinical diagnostic value, especially the diagnosis of ACL rupture with lateral meniscus injury. CONCLUSION: The diagnostic criteria and influencing factors of LFNS in diagnosis of ACL rupture are still unclear and controversial, which needs further study.

The deep lateral femoral notch sign: a reliable diagnostic tool in identifying a concomitant anterior cruciate and anterolateral ligament injury.

PURPOSE: The aim of the present study was to investigate the validity and reliability of the deep lateral femoral notch sign (DLFNS) in identifying a concomitant anterior cruciate ligament (ACL)/anterolateral ligament (ALL) rupture and predicting the clinical outcomes following an anatomical single-bundle ACL reconstruction. It was hypothesized that patients with a concomitant ACL/ALL rupture would have an increased DLFNS compared to patients without a concomitant ACL/ALL rupture. METHODS: The lateral preoperative radiographs and MRI images of 100 patients with an ACL rupture and 100 control subjects were evaluated for the presence of a DLFNS and ACL/ALL rupture, respectively. The patients were evaluated clinically preoperatively and at a minimum 1 year following the ACL reconstruction. A receiver operator curve (ROC) analysis was performed to define the optimal cut-off value of the DLFNS for identifying a concomitant ACL/ALL injury. The relative risk (RR) was also calculated to determine whether the presence of the DLFNS was a risk factor for residual instability or ACL graft rupture following an ACL reconstruction. RESULTS: The prevalence of DLFNS was 52% in the ACL-ruptured patients and 15% in the control group. At a minimum 1-year follow-up, 35% (6/17) of the patients with DLFNS > 1.8 mm complained of persistent instability, and an MRI evaluation demonstrated a graft re-rupture rate of 12% (2/17). In patients with a DLFNS < 1.8 mm, 8% (7/83) reported a residual instability, and the graft rupture rate was 2.4% (2/83). A DLFNS > 1.8 mm demonstrated a sensitivity of 89%, a specificity of 95%, a negative predictive value of 98%, and a positive predictive value of 89% in identifying a concomitant ACL/ALL rupture. Patients with a DLFNS > 1.8 mm had 4.2 times increased risk for residual instability and graft rupture compared to patients with a DLFNS ≤ 1.8 mm. CONCLUSIONS: A DLFNS > 1.8 mm could be a clinically relevant diagnostic tool for identifying a concomitant ACL/ALL rupture with high sensitivity and PPV. Patients with a DLFNS > 1.8 mm should be carefully evaluated for clinical and radiological signs of a concomitant ACL/ALL rupture and treated when needed with a combined intra-articular ACL reconstruction and extra-articular tenodesis to avoid a residual rotational instability and ACL graft rupture. LEVEL OF EVIDENCE: III.

High prevalence of a deep lateral femoral notch sign in patients with anterior cruciate ligament (ACL) and concomitant posterior root tears of the lateral meniscus.

PURPOSE: To determine the prevalence of a deep lateral femoral notch sign (LFNS) in magnetic resonance imaging (MRI) in patients with anterior cruciate ligament (ACL) and concomitant posterior root tears of the lateral meniscus (PLRT). METHODS: A retrospective chart review was conducted to identify all patients undergoing ACL reconstruction between 2016 and 2018. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: isolated ACL tear (ACL-Group), ACL tear with concomitant lateral meniscus tear not involving the posterolateral root (Meniscus-Group), and ACL tear with concomitant PLRT (PLRT-Group). Incidence and depth of a LFNS on preoperative MRI was compared between the three cohorts. RESULTS: 115 patients (mean age: 29.5 ± 11.3 years) were included in the study, with 58 patients (50.4%) assorted to the ACL-Group, 24 patients (20.9%) to the Meniscus-Group, and 33 patients (28.7%) to the PLRT-Group. The prevalence of a LFNS was significantly higher in the PLRT-Group (39.4%), when compared to the ACL- (5.2%) or Meniscus-Groups (25.0%; p < 0.001, respectively). Additionally, logistic regression analysis demonstrated that patients with PLRT were 5.3 times more likely to have a LFNS as compared to those without a lateral root tear (p < 0.001). CONCLUSION: In patients with ACL tears, the presence of a LFNS on preoperative MRI may be predictive for a PLRT. As the LFNS occurs in almost 40% of the patients with combined ACL tears and PLRT, the LFNS may be a useful secondary diagnostic finding in early MRI diagnostic. Identifying PLRT on MRI is clinically relevant, as it prevents misdiagnosis and facilitates surgical decision-making, thus avoiding subsequent delayed treatment. LEVEL OF EVIDENCE: Level IV.

Fate of the lateral femoral notch following early anterior cruciate ligament reconstruction.

BACKGROUND: The goal of this longitudinal study was to investigate the fate of the lateral femoral notch (LFN), which is frequently seen as an impaction fracture of the lateral femoral condyle in patients with anterior cruciate ligament (ACL) tears. METHODS: Patients who underwent early ACL reconstruction between 2006 and 2010 were reviewed. If post-injury magnetic resonance images showed an LFN greater than 1.5 mm in depth, patients with untreated LFN were followed. Two blinded observers performed quantitative and qualitative imaging analysis. RESULTS: Sixteen patients (five women, 11 men) were available for follow-up nine years (six to 10 years) post-injury. The median defect area of the LFN significantly decreased from 2.3 cm2 (range: 0.9-3.8 cm2) to 1.6 cm2 (range: 0.4-3.2 cm2) (P < .001). The defect depth did not significantly change from 2.3 mm (range: 2.0-3.6 mm) to 2.5 mm (range: 1.3-3.6 mm) (P > .05). The International Cartilage Repair Society (ICRS) score increased from 1.5 (range: 0-3) post-injury to 2.0 (range: 0-4) at follow-up (P < .01). The Lysholm score was 93 (72-100), the Tegner activity level was 6 (3-9) and the knee injury and osteoarthritis outcome score (KOOS) score was 97 (91-100). CONCLUSIONS: The defect area of the LFN decreased overtime, whereas the depth of the impression remained. Focal cartilage lesions were found in all except two patients post-injury and progressed during follow-up. However, patient-reported outcome scores were satisfying.

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: The combined influence of anatomic and operative factors affecting graft healing after anterior cruciate ligament (ACL) reconstruction within the femoral notch is not well understood. PURPOSE: To determine the influence of graft size and orientation in relation to femoral notch anatomy, with the signal/noise quotient (SNQ) of the graft used as a measure of graft healing after primary single-bundle ACL reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 98 patients with a minimum 2-year follow-up after primary single-bundle ACL reconstruction with hamstring tendon autografts were included. Graft healing was evaluated at 1 year on magnetic resonance imaging (MRI) scan as the mean SNQ measured from 3 regions situated at sites at the proximal, middle, and distal graft. Patient characteristics, chondropenia severity score, tunnel sizes, tunnel locations, graft bending angle (GBA), graft sagittal angle, posterior tibial slope (PTS), graft length, graft volume, femoral notch volume, and graft-notch volume ratio (measured using postoperative 3-T high-resolution MRI) were evaluated to determine any association with 1-year graft healing. The correlation between 1-year graft healing and clinical outcome at minimum 2 years was also assessed. RESULTS: There was no significant difference in mean SNQ between male and female patients (P > .05). Univariate regression analysis showed that a low femoral tunnel (P = .005), lateral tibial tunnel (P = .009), large femoral tunnel (P = .011), large tibial tunnel (P < .001), steep lateral PTS (P = .010), steep medial PTS (P = .004), acute graft sagittal angle (P < .001), acute GBA (P < .001), large graft volume (P = .003), and high graft-notch volume ratio (P < .001) were all associated with higher graft SNQ values. A multivariate regression analysis showed 2 significant factors: a large graft-notch volume ratio (P = .001) and an acute GBA (P = .004). The 1-year SNQ had a weak correlation with 2-year Tegner Activity Scale score (r = 0.227; P = .026) but no other clinical findings, such as International Knee Documentation Committee subjective and Lysholm scores and anterior tibial translation side-to-side difference. CONCLUSION: The 1-year SNQ value had a significant positive association with graft-notch volume ratio and GBA. Both graft size and graft orientation appeared to have a significant influence on graft healing as assessed on 1-year high-resolution MRI scan.

A novel morphological classification for the femoral notch based on MRI: a simple and effective assessment method for the femoral notch.

OBJECTIVE: To propose a novel morphological classification method for notches, which may provide new evidence for notchplasty based on the three-dimensional (3D) features of notches and the risk of anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS: Three hundred individuals in total were included in our study, including 150 patients with ACL ruptures (75 males and 75 females) and 150 age- and gender-matched individuals without ACL ruptures. The notches were divided into four types according to the notch widths at the notch inlet, outlet, and ACL attachment based on the preoperative MRI, the notch volume was calculated, and the risk of ACL injury was compared. The surgical records were reviewed and whether these cases performed notchplasty were collected. RESULTS: The inlet-and-outlet stenosis notch type was associated with smaller notch volume (P = 0.007) and a higher risk of ACL injury (P < 0.001). There were no significant differences in morphological distribution between males and females. The rate of notchplasty in inlet-and-outlet stenosis type was higher than the others. CONCLUSIONS: The new morphological classification method efficiently reflected the association of the notch shape with the 3D notch volume and the risk of ACL injury. The knees with the inlet-and-outlet stenosis notch type and smaller notch volume tended to have a higher risk of ACL injury. Level of evidence Level III, case-control study.

Impingement Resulting in Femoral Notching and Elevated Metal-Ion Levels After Dual-Mobility Total Hip Arthroplasty.

A 60-year-old woman underwent revision total hip arthroplasty with a modular dual-mobility articulation for recurrent dislocation. At 1-year follow-up, the patient reported no dislocations but had occasional clicking and discomfort with extreme motion. A Dunn radiograph identified notching of the femoral stem, attributed to impingement. Metal ions were elevated without adverse local-tissue reaction. After 4.5 years of observation, the notch size remained stable. She denied pain. Neither stem fracture nor prosthetic dislocation occurred. Impingement against cobalt-chromium acetabular bearing surfaces can result in notching of titanium femoral components after total hip arthroplasty. Increased anteversion intended to protect against posterior dislocation may be a risk factor. Posterior notching is best visualized on Dunn views, so incidence may be underestimated. No associated femoral implant fractures were identified on literature review.

Sex Comparisons of In Vivo Anterior Cruciate Ligament Morphometry.

CONTEXT: Females have consistently higher anterior cruciate ligament (ACL) injury rates than males. The reasons for this disparity are not fully understood. Whereas ACL morphometric characteristics are associated with injury risk and females have a smaller absolute ACL size, comprehensive sex comparisons that adequately account for sex differences in body mass index (BMI) have been limited. OBJECTIVE: To investigate sex differences among in vivo ACL morphometric measures before and after controlling for femoral notch width and BMI. DESIGN: Cross-sectional study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty recreationally active men (age = 23.2 ± 2.9 years, height = 180.4 ± 6.7 cm, mass = 84.0 ± 10.9 kg) and 20 recreationally active women (age = 21.3 ± 2.3 years, height = 166.9 ± 7.7 cm, mass = 61.9 ± 7.2 kg) participated. MAIN OUTCOME MEASURE(S): Structural magnetic resonance imaging sequences were performed on the left knee. Anterior cruciate ligament volume, width, and cross-sectional area measures were obtained from T2-weighted images and normalized to femoral notch width and BMI. Femoral notch width was measured from T1-weighted images. We used independent-samples t tests to examine sex differences in absolute and normalized measures. RESULTS: Men had greater absolute ACL volume (1712.2 ± 356.3 versus 1200.1 ± 337.8 mm3; t38 = -4.67, P < .001) and ACL width (8.5 ± 2.3 versus 7.0 ± 1.2 mm; t38 = -2.53, P = .02) than women. The ACL volume remained greater in men than in women after controlling for femoral notch width (89.31 ± 15.63 versus 72.42 ± 16.82 mm3/mm; t38 = -3.29, P = .002) and BMI (67.13 ± 15.40 versus 54.69 ± 16.39 mm3/kg/m2; t38 = -2.47, P = .02). CONCLUSIONS: Whereas men had greater ACL volume and width than women, only ACL volume remained different when we accounted for femoral notch width and BMI. This suggests that ACL volume may be an appropriate measure of ACL anatomy in investigations of ACL morphometry and ACL injury risk that include sex comparisons.

The correlation between common 2D femoral notch parameters and 3D notch volume: a retrospective MRI study.

BACKGROUND: Although the stenotic femoral intercondylar notch was associated with anterior cruciate ligament (ACL) injuries, the parameters for notch assessment were numerous. The present study aimed to compare the 2-dimensional (2D) femoral notch parameters, including the notch width (NW) and notch width index (NWI), with the 3-dimensional (3D) notch volume based on magnetic resonance imaging (MRI), to determine appropriate femoral parameters for ACL injuries. METHODS: Two hundred forty individuals were included in this study, including 120 patients with ACL ruptures and 120 age- and gender-matched individuals without ACL ruptures. The NWs and NWIs were measured at four sites (the popliteal groove, the notch inlet and outlet, and the ACL attachment), and the notch volumes were calculated. The Pearson correlation coefficients between the 2D and 3D parameters were calculated. A multivariate analysis of the ACL injuries was conducted with these parameters and the demographic data. RESULTS: The associations of the NW and NWI with the notch volume at each of the four locations of the femoral notch were poor in the subgroup analysis, with the exception of the NW in the male ACL-intact group (R = 0.307, 0.256, 0.404 and 0.387 at the popliteal groove, notch inlet and outlet, and ACL attachment, respectively). The multivariate analysis revealed that the notch volume (OR = 0.679, P < 0.001) and the NW at the popliteal groove (OR = 0.844, P = 0.004), notch inlet (OR = 0.720, P < 0.001) and ACL attachment (OR = 0.871, P = 0.028) were predictable parameters to the risk of ACL injuries. CONCLUSIONS: The correlations between the 2D parameters and the 3D volumes were weak. The notch volume and the NW at the popliteal groove, notch inlet and ACL attachment were useful parameters for predicting the risk of ACL injuries. LEVEL OF EVIDENCE: Level III, case-control study.

Can the use of femoral notch view alone decrease measurement error of distal interlocking screws after retrograde femoral nailing.

OBJECTIVES: Determine if using different fluoroscopic views of the knee (Notch or Tangential) improves accuracy of screw lengths assessment compared to the standard posteroanterior (PA). PARTICIPANTS AND METHODS: Orthopaedic surgeons at three ACGME-accredited residency programs were asked via survey to assess screw lengths on PA, femoral notch, and tangential radiographic views. RESULTS: Responders correctly identified screw length using PA, femoral notch, and medial tangential views at rates of 46.75%, 52.27%, and 44.37% respectively. Respondents detected overall screw length discrepancies most accurately using the femoral notch view (Odds Ratio 1.26; 95% confidence interval: 1.07-1.47; P < 0.005). There was no statistical difference between the residents and faculty cohort in ability to detect screw length discrepancy. CONCLUSION: Differentiating distal interlocking screw lengths on traditional imaging (AP/Notch/Tangential) is poor. The femoral notch view significantly improves accuracy in radiographic determination of screw length. The femoral notch view should be used in conjunction with the traditional PA view to maximize sensitivity and specificity for detecting prominent screws.

Assessment of relationship between three dimensional femoral notch volume and anterior cruciate ligament injury in Chinese Han adults: a retrospective MRI study.

PURPOSE: The studies of the relationship between anterior cruciate ligament (ACL) injury and notch size were in 2-D parameters in Han Chinese, the largest nation in the world, while few studies referred to the 3-D notch volume. The purpose of this study was to determine the differences in notch volume between individuals with and without ACL injuries and the optimal criterion value for abnormal notch volume and its sensitivity in predicting the risk of ACL injuries. METHODS: Two hundred eighty individuals were included in this study, including 140 patients with non-contact sports ACL injuries only and 140 age- and gender-matched individuals without ACL injuries. Both groups underwent pre-operative knee MRI examinations and femoral notches were traced manually on 2-D MRI images, then 3-D notch volume was calculated. RESULTS: The notch volume was extremely smaller in the ACL-injured group than that in the control group (5.94 ± 1.35 versus 6.86 ± 1.61 cm3, P < 0.001). The notch volume below 6.99 cm3 in males and 5.63 cm3 in females meant being prone to ACL injuries. Females tend to have smaller notch volume than males (5.53 ± 0.93 versus 7.28 ± 1.55 cm3, P < 0.001). The notch volume was in moderate correlation with the body height and weight and in weak correlation with the BMI but in no correlation with the age. CONCLUSIONS: In Chinese Han adults, the notch volume was significantly smaller in the ACL-injured individuals than in the ACL-intact ones, it was smaller in females than the males and it was correlated with the body height, weight and the BMI. Level of evidence Level III, case-control study.