Association of Geometric Characteristics of Knee Anatomy (Alpha Angle and Intercondylar Notch Type) With Noncontact ACL Injury

2021 ◽  
pp. 036354652110237
Author(s):  
Michael S. Barnum ◽  
Evan D. Boyd ◽  
Pamela Vacek ◽  
James R. Slauterbeck ◽  
Bruce D. Beynnon
Keyword(s):  
Risk Factors ◽  
Articular Cartilage ◽  
Tibial Plateau ◽  
Conditional Logistic Regression ◽  
Alpha Angle ◽  
Acl Injury ◽  
Lateral Compartment ◽  
Intercondylar Notch ◽  
Femoral Intercondylar Notch ◽  
Femoral Notch

Background: The femoral intercondylar notch type and the alpha angle (the angle between the femoral notch roof and the long axis of the femur) are easily measured in clinical settings; however, their associations with anterior cruciate ligament (ACL) injury remain unclear. Hypothesis/Purpose: The purpose was to determine if the alpha angle and the femoral notch type are associated with noncontact ACL injury univariately and in combination with previously identified knee geometric risk factors. We hypothesized that the alpha angle and the femoral notch type are associated with noncontact ACL injury and that the association differs between men and women. Study Design: Case control study; Level of evidence, 3. Methods: The alpha angle and the femoral notch type were measured via 3T magnetic resonance imaging (MRI) acquired from 61 women and 25 men with a first-time noncontact ACL injury. Each injured patient was matched with a control participant based on age, sex, and participation on the same sports team. A conditional logistic regression was used to assess univariate associations with ACL injury as well as multivariate associations using MRI-based risk factors of knee geometry identified in previous analyses: femoral intercondylar notch width at the anterior outlet, femoral intercondylar notch anteromedial ridge thickness, volume of the ACL, tibial plateau lateral compartment subchondral bone slope, lateral compartment middle articular cartilage slope, lateral compartment meniscus-cartilage height, lateral compartment meniscus-bone angle, and medial tibial spine volume. Results: For female athletes, the alpha angle (odds ratio, [OR], 1.82 per 1-degree increase; P = .001), the tibial lateral compartment articular cartilage slope (OR, 1.25 per 1-degree increase in the posterior-inferior directed slope; P = .022), and the femoral notch anteromedial ridge thickness (OR, 3.36 per 1-mm increase; P = .027) were independently associated with ACL disruption. For men, no other variables entered the models after the alpha angle was inputted as the first step (OR, 2.19 per 1-degree increase; P = .010). Conclusion: For women, ACL injury was most strongly associated with increased alpha angle, increased tibial plateau slope, and increased femoral notch ridge thickness. For men, increased alpha angle was the most significant factor associated with ACL injury. The mechanism of injury might be associated with a combination of impingement of the ACL against the bone and increased ligament loading.

scholarly journals Geometric Characteristics of the Knee Are Associated With a Noncontact ACL Injury to the Contralateral Knee After Unilateral ACL Injury in Young Female Athletes

2017 ◽  
Vol 45 (14) ◽  
pp. 3223-3232 ◽  
Author(s):  
James G. Levins ◽  
Erin C. Argentieri ◽  
Daniel R. Sturnick ◽  
Mack Gardner-Morse ◽  
Pamela M. Vacek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Articular Cartilage ◽  
Female Athletes ◽  
Acl Injury ◽  
College Level ◽  
Geometric Characteristics ◽  
Tibial Spine ◽  
Contralateral Knee ◽  
Increased Risk ◽  
Femoral Notch

Background: Contralateral anterior cruciate ligament (CACL) injury after recovery from a first-time ACL rupture occurs at a high rate in young females; however, little is known about the risk factors associated with bilateral ACL trauma. Hypothesis: The geometric characteristics of the contralateral knee at the time of the initial ACL injury are associated with risk of suffering a CACL injury in these female athletes. Study Design: Case-control study; Level of evidence, 3. Methods: Sixty-two female athletes who suffered their first noncontact ACL injury while participating in sports at the high school or college level were identified, and geometry of the femoral notch, ACL, tibial spines, tibial subchondral bone, articular cartilage surfaces, and menisci of the contralateral, uninjured, knee was characterized in 3 dimensions. We were unable to contact 7 subjects and followed the remaining 55 until either a CACL injury or an ACL graft injury occurred or, if they were not injured, until the date of last contact (mean, 34 months after their first ACL injury). Cox regression was used to identify risk factors for CACL injury. Results: Ten (18.2%) females suffered a CACL injury. Decreases of 1 SD in femoral intercondylar notch width (measured at its outlet and anterior attachment of the ACL) were associated with increases in the risk of suffering a CACL injury (hazard ratio = 1.88 and 2.05, respectively). Likewise, 1 SD decreases in medial-lateral width of the lateral tibial spine, height of the medial tibial spine, and thickness of the articular cartilage located at the posterior region of the medial tibial compartment were associated with 3.59-, 1.75-, and 2.15-fold increases in the risk of CACL injury, respectively. Conclusion: After ACL injury, subsequent injury to the CACL is influenced by geometry of the structures that surround the ACL (the femoral notch and tibial spines). This information can be used to identify individuals at increased risk for CACL trauma, who might benefit from targeted risk-reduction interventions.

A Comparison of the Compressive and Shear Stiffness of Periarticular Osteophytes, Hypertrophic Femoral Intercondylar Notch and Normal Articular Cartilage

1998 ◽  
Vol 02 (03) ◽  
pp. 247-255
Author(s):  
Temitope O. Alonge ◽  
Olusola O. A. Oni ◽  
Colin J. Morrison
Keyword(s):  
Articular Cartilage ◽  
Shear Force ◽  
Shear Stiffness ◽  
Osteochondral Graft ◽  
Intercondylar Notch ◽  
Articular Cartilage Defect ◽  
Hardening Material ◽  
Suitable Material ◽  
Femoral Intercondylar Notch ◽  
Shear Characteristics

The compressive and shear stiffness of periarticular osteophytes, hypertrophic femoral intercondylar notch and normal articular cartilage were compared by obtaining force-indentation curves and applying a shear force to the cartilage/bone interface. The primary stiffness (at 0–100N load) was similar for osteophytes (391N/mm), intercondylar notch (400N/mm) and normal articular cartilage (401N/mm). By contrast, the secondary stiffness (at 100–500N load) was much higher for the intercondylar notch (493N/mm) compared to the osteophytes (410N/mm). There were two varieties of osteophytes, "pink" and "white". Compared with "pink" osteophytes, "white" osteophytes exhibited features similar to a progressively hardening material and appear to be a more mechanically suitable material as an osteochondral graft for full thickness articular cartilage defect. The shear characteristics of all the samples were similar.

T2 Mapping Values in Postmeniscectomy Knee Articular Cartilage after Running: Early Signs of Osteoarthritis?

2020 ◽  
Author(s):  
Dror Lindner ◽  
Yigal Chechik ◽  
Yiftah Beer ◽  
Sigal Tal ◽  
Oleg Lysyy ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Tibial Plateau ◽  
T2 Mapping ◽  
Lateral Compartment ◽  
Partial Meniscectomy ◽  
Mapping Technique ◽  
Anterior Tibial ◽  
Before And After ◽  
Healthy Knee ◽  
Magnetic Resonance Imaging Mri

AbstractLoading on the joints during running may have a deleterious effect on post–partial meniscectomy knee cartilage, leading to osteoarthritis. Utilizing T2-mapping measurements before and after running may enable the observation of changes in the articular cartilage of the postmeniscectomy knees compared with healthy knees. After medial partial meniscectomy, 12 volunteers underwent magnetic resonance imaging (MRI) of the both knees, before and immediately after 30 minutes of running. Quantitative assessment of articular cartilage was performed using a T2-mapping technique. In the medial compartment of the operated knees, significantly lower T2 values were found in anterior tibial plateau (pre- vs. postrun: 33.85 vs. 30.45 ms; p = 0.003) and central tibial plateau (33.33 vs. 30.63 ms; p = 0.007). Similar differences were found in lateral regions of central femur (post- vs. prerun: 35.86 vs. 40.35 ms; p = 0.015), posterior femur (34.89 vs. 37.73 ms; p = 0.001), and anterior tibia (24.66 vs. 28.70 ms, p = 0.0004). In lateral compartment, postrun values were significantly lower in operated compared with healthy knees, in central femur (34.89 vs. 37.59 ms; p = 0.043), posterior femoral (36.88 vs. 39.36 ms; p = 0.017), anterior tibia (24.66 vs. 30.20 ms; p = 0.009), and posterior tibia (28.84 vs. 33.17 ms; p = 0.006). No statistical difference was found while comparing postrun to prerun healthy knees. Lower T2 values were found in operated knees after 30 minutes of running. These changes were seen in medial and lateral compartments. We suspect that running may subject the articular cartilage to excessive loads in the post–partial meniscectomy knee, loads that in healthy knee do not cause any changes.

scholarly journals ACL Size and Notch Width Between ACLR and Healthy Individuals: A Pilot Study

2019 ◽  
Vol 12 (1) ◽  
pp. 61-65
Author(s):  
Hsin-Min Wang ◽  
Sandra J. Shultz ◽  
Scott E. Ross ◽  
Robert A. Henson ◽  
David H. Perrin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Size ◽  
Effect Size ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Healthy Individuals ◽  
Level Of Evidence ◽  
Notch Width ◽  
Femoral Notch ◽  
Notch Width Index

Background: Given the relatively high risk of contralateral anterior cruciate ligament (ACL) injury in patients with ACL reconstruction (ACLR), there is a need to understand intrinsic risk factors that may contribute to contralateral injury. Hypothesis: The ACLR group would have smaller ACL volume and a narrower femoral notch width than healthy individuals after accounting for relevant anthropometrics. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: Magnetic resonance imaging data of the left knee were obtained from uninjured (N = 11) and unilateral ACL-reconstructed (N = 10) active, female, collegiate-level recreational athletes. ACL volume was obtained from T2-weighted images. Femoral notch width and notch width index were measured from T1-weighted images. Independent-samples t tests examined differences in all measures between healthy and ACLR participants. Results: The ACLR group had a smaller notch width index (0.22 ± 0.02 vs 0.25 ± 0.01; P = 0.004; effect size, 1.41) and ACL volume (25.6 ± 4.0 vs 32.6 ± 8.2 mm3/(kg·m)−1; P = 0.025; effect size, 1.08) after normalizing by body size. Conclusion: Only after normalizing for relevant anthropometrics, the contralateral ACLR limb had smaller ACL size and narrower relative femoral notch size than healthy individuals. These findings suggest that risk factor studies of ACL size and femoral notch size should account for relevant body size when determining their association with contralateral ACL injury. Clinical Relevance: The present study shows that the method of the identified intrinsic risk factors for contralateral ACL injury could be used in future clinical screening settings.

scholarly journals Articular Cartilage and Meniscus Risk Factors of Patient-Reported Outcomes 10 Years after ACL Reconstruction: A Multicenter Cohort Study (160)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0028
Author(s):  
Robert Brophy ◽  
Laura Huston ◽  
Isaac Briskin ◽  
Kurt Spindler ◽  
Keyword(s):  
Risk Factors ◽  
Articular Cartilage ◽  
Tibial Plateau ◽  
Medial Meniscus ◽  
Femoral Condyle ◽  
Activity Level ◽  
Meniscus Tears ◽  
Patient Reported ◽  
Meniscus Surgery

Objectives: Articular cartilage and meniscal damage are commonly encountered and often treated at the time of anterior cruciate ligament reconstruction (ACLR). Our understanding of how these injuries and their treatment relate to outcomes of ACLR is still evolving. The purpose of this study was to assess whether articular cartilage and meniscal variables are predictive of 10-year outcomes after ACLR. We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 10-year follow-up after ACLR. Methods: Between 2002 and 2008, 3273 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, 6, and 10 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the risk factors of IKDC, KOOS, and Marx at 10 years. Results: We completed a minimum follow-up on 77% (2530/3273) of our cohort at 10 years. The cohort was 56% male with a median age of 23 years at the time of enrollment. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-22%, lateral femoral condyle [LFC]-15%, medial tibial plateau [MTP]-4%, lateral tibial plateau [LTP]-11%, patella-18%, trochlear-8%) and meniscal (medial-37%, lateral-46%). Variables that were predictive of 10-year outcomes included articular cartilage damage in the patellofemoral and medial compartments and previous medial meniscus surgery (6% of knees) (Table). Medial and lateral meniscus tears and treatment at the time of ACLR were not associated with 10-year outcomes. Other variables that significantly influenced 10-year outcomes included sex, race, BMI, type of reconstruction (primary vs. revision), baseline outcome scores, and MCL pathology (5.5% of knees). Conclusions: Articular cartilage injury in the patellofemoral and medial compartments at the time of ACLR and a history of medial meniscus surgery prior to ACLR are associated with 10-year ACLR outcomes. However, meniscal tears/treatment at the time of ACLR did not predict 10-year outcomes.

scholarly journals The Relationship Between Discoid Meniscus and Articular Cartilage Thickness: A Quantitative Observational Study With MRI

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110622
Author(s):  
Joseph M. Brutico ◽  
Margaret L. Wright ◽  
Sarah I. Kamel ◽  
Adam C. Zoga ◽  
Kirsten Poehling-Monaghan ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Tibial Plateau ◽  
Lateral Meniscus ◽  
Lateral Compartment ◽  
Cartilage Thickness ◽  
Discoid Meniscus ◽  
Meniscal Tissue ◽  
Significant Difference ◽  
The Mean ◽  
The Relationship

Background: Several cadaveric imaging studies have demonstrated that the articular cartilage thickness on the tibial plateau varies depending on coverage by native meniscal tissue. These differences are thought to partially contribute to the rates of cartilage degeneration and development of osteoarthritis after meniscectomy. Because there is greater tibial plateau coverage with meniscal tissue in the setting of a discoid meniscus, these findings may also have implications for the long-term health of the knee after saucerization of a torn discoid meniscus. Purpose: To evaluate the relationship between lateral compartment articular cartilage thickness and the presence or absence of a discoid meniscus. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included in the study were 25 patients younger than 40 years of age who had undergone a 1.5-T or 3-T knee magnetic resonance imaging (MRI) between 2010 and 2016 at a single institution and had an intact, lateral discoid meniscus. Only patients with an otherwise asymptomatic lateral compartment were included. The authors then identified 35 age-matched controls with a nondiscoid, intact lateral meniscus who underwent knee MRI at the same institution and during the same period. The articular cartilage thicknesses in 6 zones of the lateral femoral condyle (LFC) and lateral tibial plateau (LTP) were measured for each patient by 2 musculoskeletal radiologists, and the mean thicknesses were compared between the study and control groups. Results: The average age at MRI was 22.63 years (range, 8.30-35.90 years) for the discoid group and 20.93 years (range, 8.43-34.99 years) for the nondiscoid group. The nondiscoid group had significantly greater mean articular cartilage thickness in all 6 zones of the LTP ( P < .05 for all). When comparing the zones of the LFC, there was no significant difference in the mean thickness in any zone between the 2 groups. Conclusion: Patients with discoid menisci had thinner baseline articular cartilage thickness in the LTP compared with those patients without discoid menisci.

Differences in Femoral Notch Anatomy between Men and Women

2002 ◽  
Vol 30 (3) ◽  
pp. 329-333 ◽  
Author(s):  
William P. H. Charlton ◽  
Thomas A. St. John ◽  
Michael G. Ciccotti ◽  
Nichol Harrison ◽  
Mark Schweitzer
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Cruciate Ligament ◽  
Intercondylar Notch ◽  
Resonance Imaging ◽  
Men And Women ◽  
Femoral Intercondylar Notch ◽  
Anterior Cruciate ◽  
Femoral Notch

Background Research has shown that variations in femoral intercondylar notch morphometry may be a predisposing factor for noncontact anterior cruciate ligament injury. Hypothesis There are anatomic differences in the anterior cruciate ligament and femoral notch between men and women. Study Design Descriptive anatomic study. Methods Using magnetic resonance imaging, we performed a three-dimensional analysis of the femoral intercondylar notch morphometry to look for differences in femoral notch and anterior cruciate ligament volumes between men and women. Axial plane magnetic resonance imaging scans were performed on 96 knees in 48 asymptomatic subjects. Digital measurements were taken of femoral notch area, anterior cruciate ligament area, notch width, and bicondylar width, within defined parameters of the femoral notch. The notch and anterior cruciate ligament volumes were then calculated. Analysis of variance was performed using sex, height, and weight as covariates. Results The volume of the femoral notch was found to be statistically smaller in women compared with men; this difference was primarily related to height. A similar relationship was found for anterior cruciate ligament volume. A statistically significant correlation was found between femoral notch volume and anterior cruciate ligament volume; patients with smaller notches also had smaller anterior cruciate ligaments. Conclusions Our results suggest that there is a difference in femoral notch and anterior cruciate ligament volume between men and women, which, in turn, is related to differences in height and weight.

Clinical-Grade MRI-Based Methods to Identify Combined Anatomic Factors That Predict ACL Injury Risk in Male and Female Athletes

2021 ◽  
pp. 036354652110242
Author(s):  
Mélanie L. Beaulieu ◽  
Emma K. Nowak ◽  
Bruce D. Beynnon ◽  
James A. Ashton-Miller ◽  
Daniel R. Sturnick ◽  
...  
Keyword(s):  
Injury Risk ◽  
Wedge Angle ◽  
Acl Injury ◽  
Lateral Compartment ◽  
Magnetic Resonance Images ◽  
Screening Tools ◽  
Clinical Grade ◽  
Femoral Intercondylar Notch ◽  
Acl Injury Risk ◽  
Research Grade

Background: Recently developed multivariate sex-specific statistical models can predict anterior cruciate ligament (ACL) injury risk using various knee anatomic factors. However, screening tools able to identify individuals at an increased injury risk are unlikely to be developed based on these models, given that sophisticated and time-consuming methods were used to measure those factors on research-grade resolution magnetic resonance images (MRIs). Purpose: To determine whether simpler methods, amenable to using clinical-grade resolution MRIs, can identify the same knee anatomic factors previously found to contribute to ACL injury risk using sophisticated methods and research-grade resolution images. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: High-resolution 3-dimensional MRIs previously acquired from 87 patients with primary, noncontact, grade III ACL injury and 87 uninjured matched control participants for a series of published studies were downgraded to clinical-grade resolution images. The 4 knee anatomic factors found to contribute to ACL injury risk in women and in men in these published studies—femoral intercondylar notch width at the anterior outlet of the ACL (NW_O), posterior-inferior directed slope of the middle region articular cartilage surface of the tibial plateau’s lateral compartment (LatTibMCS), ACL volume, and tibial plateau’s lateral compartment posterior meniscus to subchondral bone wedge angle (LatTibMBA)—were measured using clinical-grade resolution MRI-based methods. Stepwise multivariate conditional logistic regressions were used to identify the combinations of factors most highly associated with an ACL injury risk in women and men separately. Results: The multivariate model that best predicted ACL injury risk in the female participants included the LatTibMCS and the NW_O. For the male participants, this model included the ACL volume and the LatTibMBA. These results corroborate the previously published results that reported models with the same knee anatomic factors to best predict injury risk in this group of young women and men. Conclusion: Simpler methods using MRIs downgraded to a clinical-grade resolution can identify the same knee anatomic factors previously found to significantly contribute to ACL injury risk using sophisticated methods and research-grade resolution MRIs.

Tibiofemoral Contact Pressures and Osteochondral Microtrauma during Anterior Cruciate Ligament Rupture Due to Excessive Compressive Loading and Internal Torque of the Human Knee

2008 ◽  
Vol 36 (10) ◽  
pp. 1966-1977 ◽  
Author(s):  
Eric G. Meyer ◽  
Timothy G. Baumer ◽  
Jill M. Slade ◽  
Walter E. Smith ◽  
Roger C. Haut
Keyword(s):  
Magnetic Resonance Imaging ◽  
Articular Cartilage ◽  
Subchondral Bone ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Compressive Loading ◽  
Acl Injury ◽  
Resonance Imaging ◽  
Human Knee ◽  
Anterior Cruciate

Background The knee is one of the most frequently injured joints, including 80 000 anterior cruciate ligament (ACL) tears in the United States each year. Bone bruises are seen in over 80% of patients with ACL injuries, and have been associated with an overt loss of cartilage overlying those regions within 6 months of injury. Hypothesis The level of contact pressure developed in the human knee joint and the extent of articular cartilage and underlying subchondral bone injuries will depend on the mechanism of applied loads/moments during rupture of the ACL. Study Design Controlled laboratory study. Methods Seven knee pairs, flexed to 30°, were loaded in compression or internal torsion until injury. Pressure-sensitive film recorded the magnitude and location of contact. Histologic analysis and magnetic resonance imaging were used to document microtrauma to the tibial plateau cartilage and subchondral bone. Results All specimens suffered ACL injury, either in the form of a midsubstance rupture or avulsion fracture. The contact area and pressures were higher for compression than torsion experiments. After being loaded, the articular cartilage in the central and posterior regions of the medial tibial plateau showed increased magnetic resonance imaging signal intensity, corresponding to an increased susceptibility to absorb water. Histologically, there were more microcracks in the subchondral bone and more articular cartilage damage in the compression than torsion experiments. Conclusion Significant damage occurs to the articular cartilage and underlying subchondral bone during rupture of the ACL. The types and extent of these tissue injuries are a function of the mechanism of ACL rupture. Clinical Relevance Patients suffering an ACL injury may be at risk of osteochondral damage, especially if the mechanism of injury involves a high compressive loading component, such as during a jump landing.

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