The Anterior Notch Area for 3 Types of Notch Geometry, an Individualized Approach for Choosing the ACL Graft Size.

Background: The intercondylar notch (ICN) is an important element of knee morphometry, in close relation to the anterior cruciate ligament (ACL). To find the average are of the anterior notch in each ICN specific shape (A-, W-, or U-shape). Methods: Magnetic resonance imaging (MRI) scans were independently analyzed by two experts, one orthopedic surgeon and one imaging physician. In all cases, the following measurements were done according to the existing definitions: ICN type, aICN area. Results: 65 cases (A-35.4%, W-26.2%, U-38,5%) were included in study; A and W notch types have smaller aICN areas, while U-type notch has bigger aICN area. Conclusion: The anterior intercondylar notch area varies significantly for each specific shape (A-, W, or U-shape), and does not corelates with height. This needs to be considered during ACL reconstruction, when choosing graft size.

Balancing Anterior and Posterior Cruciate Ligaments in Adults.

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.

Anterior Intercondylar Notch Geometry in Relation to the Native Anterior Cruciate Ligament Size.

BACKGROUND: The intercondylar notch (ICN) and the anterior cruciate ligament (ACL) are important structures in knee morphometry, with key roles in stabilizing the knee. AIM: To determine the associations between the specific shape of the ICN (A-, W-, or U-shape) and the ACL size in patients with intact ACLs. METHODS: Magnetic resonance imaging (MRI) scans were independently analyzed by two experts: one orthopedic surgeon and one imaging physician. In all cases, the following measurements were taken based on the existing definitions: ACL area, anterior ICN (aICN) area, ICN width, lateral trochlear inclination (LTI), and Insall-Salvati index. RESULTS: A total of 65 cases (50.8% male; 33.8 ± 10.2 years mean age at inclusion) were included in the study. The ACL and aICN areas were significantly larger in patients with U-shaped compared with A-shaped and W-shaped ICNs: 0.50 (0.20-0.80) vs. 0.40 (0.20-0.80) vs. 0.40 (0.30-0.80), p = 0.011 and 1.16 (0.57-3.60) vs. 0.47 (0.15-0.95) vs. 0.37 (0.15-0.81), p < 0.001, respectively. Internal meniscal lesions were more common in cases with U-shaped ICNs (64.0%), while external ones were more common in W-shaped ICN cases (35.3%). None of the A-shaped cases had external chondral or meniscal lesions. The ACL area was significantly larger in males and internal meniscal injuries, with no differences between chondral lesions, external meniscal injuries, patellar chondral lesions, patella alta, or trochlear dysplasia. CONCLUSION: The specific shape of the intercondylar notch was associated with the anterior cruciate ligament-anterior intercondylar notch (ACL-aICN) area size correlation, with a strong correlation between ACL and aICN area when the intercondylar notch was A-shaped or W-shaped, and a low correlation when the notch was U- shaped. The specific shape of the intercondylar notch (A-, W-, or U-shape) was associated with the occurrence of both internal and external meniscal injuries, with the U-shaped intercondylar notch morphometry being more frequent in cases with internal meniscal injuries and the W-shape being more common in cases with external meniscal injuries.

Functional Outcome Prediction after Traumatic Spinal Cord Injury Based on Acute Clinical Factors.

Spinal cord injury (SCI) is a devastating condition that affects patients on both a personal and societal level. The objective of the study is to improve the prediction of long-term functional outcome following SCI based on the acute clinical findings. A total of 76 patients with acute traumatic SCI were prospectively enrolled in a cohort study in a single Level I trauma center. Spinal Cord Independence Measure (SCIM) at 1 year after the trauma was the primary outcome. Potential predictors of functional outcome were recorded during the acute hospitalization: age, sex, level and type of injury, comorbidities, American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA Motor Score (AMS), ASIA Light Touch score (LT), ASIA Pin Prick score (PP), Injury Severity Score (ISS), traumatic brain injury, and delay from trauma to surgery. A linear regression model was created with the primary outcome modeled relative to the acute clinical findings. Only four variables were selected in the model, with performance averaging an R-square value of 0.57. In descending order, the best predictors for SCIM at 1 year were: LT, AIS grade, ISS, and AMS. One-year functional outcome (SCIM) can be estimated by a simple equation that takes into account four parameters of the initial physical examination. Estimating the patient long-term outcome early after traumatic SCI is important in order to define the management strategies that might diminish the costs and to give the patient and family a better view of the long-term expectations.

Patient Specific Instruments for Complex Tumor Resection-Reconstruction Surgery within the Pelvis: A Series of 4 Cases.

The pelvis bone resection-reconstruction surgery is one of the most challenging fields in orthopedics. Being applied for tumors, as for other complex reconstruction cases, this type of surgery needs careful planning and is time consuming, in order to obtain proper accuracy. Unfortunately not all the time the expected accuracy is met, with consequences for the patients. PSI proved to provide good cutting accuracy during simulated tumor surgery within the pelvis. This article present a series of 4 patients operated in our department between June 2014 and Mars 2015 for tumors resectionreconstructions. The patients were imaged using a CT and an MRI scan and the images were reconstructed in 3D. According to the bone bank stock, the most similar allograft was chosen and the stored CT scan was reconstructed in 3D. Patient specific instruments (PSI) were designed and manufactured using rapid-prototyping technology for the resection of the native tissues as for the resection of the careful selected hemipelvic allografts. Allografts fitting to the pelvis of the patients was excellent and allowed stable osteosynthesis.