Relationship Between the Risk of Suffering a First-Time Noncontact ACL Injury and Geometry of the Femoral Notch and ACL

Abstract

Background:

The morphometric characteristics of the anterior cruciate ligament (ACL) and the femoral intercondylar notch within which it resides have been implicated as risk factors for injuries to this important stabilizer of the knee. Prior research has produced equivocal results with differing methodologies, and consequently, it is unclear how these characteristics affect the injury risk in male and female patients.

Hypothesis:

The morphometric characteristics of the ACL and femoral intercondylar notch are individually and independently associated with the risk of suffering a noncontact ACL injury, and these relationships are different in male and female patients.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Magnetic resonance imaging scans of the bilateral knees were obtained on 88 case-control pairs (27 male, 61 female) matched for age, sex, and participation on the same sports team. Patients had suffered a grade III, first-time, noncontact ACL tear. The femoral notch width at 4 locations, the thickness of the bony ridge at the anteromedial outlet of the femoral notch, the femoral notch volume, ACL volume, and ACL cross-sectional area were measured.

Results:

Multivariate analysis of combined data from male and female patients revealed that decreased ACL volume (odds ratio [OR], 0.829), decreased femoral notch width (OR, 0.700), and increased bony ridge thickness at the anteromedial outlet of the femoral notch (OR, 1.614) were significant independent predictors of an ACL injury. Separate analyses of male and female patients indicated that the femoral notch ridge may be more strongly associated with a risk in female patients, while ACL volume is more strongly associated with a risk in male patients. However, statistical analysis performed with an adjustment for body weight strengthened the association between ACL volume and the risk of injuries in female patients.

Conclusion:

Morphometric features of both the ACL and femoral notch combine to influence the risk of suffering a noncontact ACL injury. When included together in a multivariate model that adjusts for body weight, the effects of the morphometric measurements are similar in male and female patients. If body weight is not taken into consideration, ACL volume is not associated with a risk in female patients.

Keywords

ACL femoral intercondylar notch knee anatomy

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References

Al-Saeed

Brown

Athyal

Sheikh

. Association of femoral intercondylar notch morphology, width index and the risk of anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 2013;21(3):678-682.

Alizadeh

Kiavash

. Mean intercondylar notch width index in cases with and without anterior cruciate ligament tears. Iran J Radiol. 2008;5(4):205-208.

Anderson

Gorman

Cross

Spindler

. Radiographic measurements of the intercondylar notch: are they accurate? Arthroscopy. 2007;23(3):261-268, 268.e1-268.e2.

Anderson

Dome

Gautam

Awh

Rennirt

. Correlation of anthropometric measurements, strength, anterior cruciate ligament size, and intercondylar notch characteristics to sex differences in anterior cruciate ligament tear rates. Am J Sports Med. 2001;29(1):58-66.

Anderson

Lipscomb

Liudahl

Addlestone

. Analysis of the intercondylar notch by computed tomography. Am J Sports Med. 1987;15(6):547-552.

Beynnon

Hall

Sturnick

. An increase of the posterior-inferior directed slope of the lateral tibial plateau subchondral bone is associated with an increased risk of suffering a non-contact ACL injury: a prospective cohort study with a nested, matched case-control analysis. Am J Sports Med. 2014;42(5):1039-1048.

Chandrashekar

Slauterbeck

Hashemi

. Sex-based differences in the anthropometric characteristics of the anterior cruciate ligament and its relation to intercondylar notch geometry: a cadaveric study. Am J Sports Med. 2005;33(10):1492-1498.

Charlton

St John

Ciccotti

Harrison

Schweitzer

. Differences in femoral notch anatomy between men and women: a magnetic resonance imaging study. Am J Sports Med. 2002;30(3):329-333.

Davis

Shelbourne

Klootwyk

. Correlation of the intercondylar notch width of the femur to the width of the anterior and posterior cruciate ligaments. Knee Surg Sports Traumatol Arthrosc. 1999;7(4):209-214.

10.

Dienst

Schneider

Altmeyer

. Correlation of intercondylar notch cross sections to the ACL size: a high resolution MR tomographic in vivo analysis. Arch Orthop Trauma Surg. 2007;127(4):253-260.

11.

Domzalski

Grzelak

Gabos

. Risk factors for anterior cruciate ligament injury in skeletally immature patients: analysis of intercondylar notch width using magnetic resonance imaging. Int Orthop. 2010;34(5):703-707.

12.

Ellaszlw

Young

Woodbury

Fryday-Field

. Statisitical methodology for the concurrent assessment of interrater and intrarater reliability: using goniometric measurements as an example. Phys Ther. 1994;74:777-788.

13.

Everhart

Flanigan

Chaudhari

. Anteromedial ridging of the femoral intercondylar notch: an anatomic study of 170 archival skeletal specimens. Knee Surg Sports Traumatol Arthrosc. 2014;22(1):80-87.

14.

Everhart

Flanigan

Simon

Chaudhari

. Association of noncontact anterior cruciate ligament injury with presence and thickness of a bony ridge on the anteromedial aspect of the femoral intercondylar notch. Am J Sports Med. 2010;38(8):1667-1673.

15.

Fung

Hendrix

Koh

Zhang

. ACL impingement prediction based on MRI scans of individual knees. Clin Orthop Relat Res. 2007;460:210-218.

16.

Goetschius

Smith

Vacek

. Application of a clinic-based algorithm as a tool to identify female athletes at risk for anterior cruciate ligament injury: a prospective cohort study with a nested, matched case-control analysis. Am J Sports Med. 2012;40(9):1978-1984.

17.

Gwinn

Wilckens

McDevitt

Ross

Kao

. The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy. Am J Sports Med. 2000;28(1):98-102.

18.

Herzog

Silliman

Hutton

Rodkey

Steadman

. Measurements of the intercondylar notch by plain film radiography and magnetic resonance imaging. Am J Sports Med. 1994;22(2):204-210.

19.

Hoteya

Kato

Motojima

. Association between intercondylar notch narrowing and bilateral anterior cruciate ligament injuries in athletes. Arch Orthop Trauma Surg. 2011;131(3):371-376.

20.

Houseworth

Mauro

Mellon

Kieffer

. The intercondylar notch in acute tears of the anterior cruciate ligament: a computer graphics study. Am J Sports Med. 1987;15(3):221-224.

21.

Ireland

Ballantyne

Little

McClay

. A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 2001;9(4):200-205.

22.

Kocher

Mandiga

Klingele

Bley

Micheli

. Anterior cruciate ligament injury versus tibial spine fracture in the skeletally immature knee: a comparison of skeletal maturation and notch width index. J Pediatr Orthop. 2004;24(2):185-188.

23.

LaPrade

Burnett

2nd . Femoral intercondylar notch stenosis and correlation to anterior cruciate ligament injuries: a prospective study. Am J Sports Med. 1994;22(2):198-202, discussion 203.

24.

Lombardo

Sethi

Starkey

. Intercondylar notch stenosis is not a risk factor for anterior cruciate ligament tears in professional male basketball players: an 11-year prospective study. Am J Sports Med. 2005;33(1):29-34.

25.

Lund-Hanssen

Gannon

Engebretsen

Holen

Anda

Vatten

. Intercondylar notch width and the risk for anterior cruciate ligament rupture: a case-control study in 46 female handball players. Acta Orthop Scand. 1994;65(5):529-532.

26.

Prodromos

Han

Rogowski

Joyce

Shi

. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy. 2007;23(12):1320-1325.e6.

27.

Schickendantz

Weiker

. The predictive value of radiographs in the evaluation of unilateral and bilateral anterior cruciate ligament injuries. Am J Sports Med. 1993;21(1):110-113.

28.

Shelbourne

Davis

Klootwyk

. The relationship between intercondylar notch width of the femur and the incidence of anterior cruciate ligament tears: a prospective study. Am J Sports Med. 1998;26(3):402-408.

29.

Shelbourne

Facibene

Hunt

. Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc. 1997;5(4):229-233.

30.

Simon

Everhart

Nagaraja

Chaudhari

. A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech. 2010;43(9):1702-1707.

31.

Smith

Johnson

Shultz

. A prospective evaluation of the Landing Error Scoring System (LESS) as a screening tool for anterior cruciate ligament injury risk. Am J Sports Med. 2012;40(3):521-526.

32.

Smith

Vacek

Johnson

. Risk factors for anterior cruciate ligament injury: a review of the literature. Part 1: neuromuscular and anatomic risk. Sports Health. 2012;4(1):69-78.

33.

Souryal

. The predictive value of radiographs in the evaluation of unilateral and bilateral anterior cruciate ligament injuries. Am J Sports Med. 1993;21(6):898.

34.

Souryal

Moore

Evans

. Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis. Am J Sports Med. 1988;16(5):449-454.

35.

Spindler

Wright

. Clinical practice: anterior cruciate ligament tear. N Engl J Med. 2008;359(20):2135-2142.

36.

Staeubli

Adam

Becker

Burgkart

. Anterior cruciate ligament and intercondylar notch in the coronal oblique plane: anatomy complemented by magnetic resonance imaging in cruciate ligament-intact knees. Arthroscopy. 1999;15(4):349-359.

37.

van Diek

Wolf

Murawski

van Eck

. Knee morphology and risk factors for developing an anterior cruciate ligament rupture: an MRI comparison between ACL-ruptured and non-injured knees. Knee Surg Sports Traumatol Arthrosc. 2014;22(5):987-994.

38.

van Eck

Kopf

van Dijk

Tashman

. Comparison of 3-dimensional notch volume between subjects with and subjects without anterior cruciate ligament rupture. Arthroscopy. 2011;27(9):1235-1241.

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