scholarly journals What is the impact of knee morphology on posterior cruciate ligament avulsion fracture in men and women: a case control study

2020 ◽  
Author(s):  
Ning Fan ◽  
Yong-chen Zheng ◽  
Lei Zang ◽  
Cheng-gang Yang ◽  
Shuo Yuan ◽  
...  
Keyword(s):  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Binary Logistic Regression ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
Notch Width ◽  
Lateral Posterior ◽  
The Impact ◽  
Pcl Avulsion ◽  
Notch Width Index

Abstract Background Several studies on the relationship between morphological parameters and traumatic diseases of the knee have already been conducted. However, few studies focused on the association between knee morphology and posterior cruciate ligament (PCL) avulsion fracture in adults. The objective of this study was to evaluate the impact of knee morphology on PCL avulsion fracture and determine risk factors in men and women separately. Methods A retrospective case-control study of 48 patients (comprised 25 men and 23 women) with PCL avulsion fracture compared with 48 age- and sex-matched controls was performed from 2012 to 2018. MRI measurements of the knee were acquired in the sagittal, coronal, and axial sequences. The assessed measurements including intercondylar notch width index, medial/lateral posterior tibial slopes, and coronal tibial slope were compared between case and control groups in both women and men. Univariable and binary logistic regression analyses were used to identify independent risk factors that were associated with PCL avulsion fracture. Results When female patients were analyzed, the notch width index (coronal) was significantly smaller, and the lateral posterior tibial slope was significantly higher in the case group. The binary logistic regression analysis showed that the notch width index (coronal) (B = -0.307, OR = 0.735, p = 0.025) was found to be an independent factor. When male patients were analyzed, no radiographic parameter was found to have a statistical difference between the case and control groups. Conclusions Notch width index (coronal) and lateral posterior tibial slope were found to affect PCL avulsion fracture in women, but no such measurements affected the PCL avulsion fracture in men. Furthermore, a smaller notch width index (coronal) in women was found to be a risk factor in PCL avulsion fracture.

scholarly journals What is the impact of knee morphology on posterior cruciate ligament avulsion fracture in men and women: a case control study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ning Fan ◽  
Yong-chen Zheng ◽  
Lei Zang ◽  
Cheng-gang Yang ◽  
Shuo Yuan ◽  
...  
Keyword(s):  
Avulsion Fracture ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Control Groups ◽  
Posterior Tibial ◽  
Notch Width ◽  
Lateral Posterior ◽  
And Control ◽  
Pcl Avulsion ◽  
Notch Width Index

Abstract Background Several studies on the relationship between morphological parameters and traumatic diseases of the knee have already been conducted. However, few studies focused on the association between knee morphology and posterior cruciate ligament (PCL) avulsion fracture in adults. The objective of this study was to evaluate the impact of knee morphology on PCL avulsion fracture. Methods 76 patients (comprised 40 men and 36 women) with PCL avulsion fracture and 76 age- and sex-matched controls without PCL avulsion fracture were studied from 2012 to 2020. MRI measurements of the knee were acquired in the sagittal, coronal, and axial planes. The assessed measurements including intercondylar notch width index, coronal tibial slope, and medial/lateral posterior tibial slopes were compared between men and women, and between case and control groups respectively using independent sample t-tests. In addition, binary logistic regression analyses were used to identify independent risk factors of PCL avulsion fracture. Results Except notch width index (coronal) (p = 0.003) in the case groups, there was no statistical difference in the assessed measurements including notch width index (axial), coronal tibial slope, medial posterior tibial slope, and lateral posterior tibial slope between men and women in the case and control groups (p > 0.05). When female patients were analyzed, the notch width index (coronal) was significantly smaller (p = 0.0004), the medial posterior tibial slope (p = 0.018) and the lateral posterior tibial slope (p = 0.033) were significantly higher in the case group. The binary logistic regression analysis showed that the notch width index (coronal) (B = -0.347, OR = 0.707, p = 0.003) was found to be an independent factor of PCL avulsion fracture. However, none of the assessed measurements was found to have a statistical difference between the case and control groups in men (p > 0.05). Conclusions Notch width index (coronal), medial posterior tibial slope, and lateral posterior tibial slope were found to affect PCL avulsion fracture in women, but no such measurements affected the PCL avulsion fracture in men. Furthermore, a smaller notch width index (coronal) in women was found to be a risk factor in PCL avulsion fracture.

Narrow Notch Width and Low Anterior Cruciate Ligament Volume Are Risk Factors for Anterior Cruciate Ligament Injury: A Magnetic Resonance Imaging-Based Study

2021 ◽  
pp. 155633162110410
Author(s):  
Ravi Gupta ◽  
Sanjay Jhatiwal ◽  
Anil Kapoor ◽  
Ravinder Kaur ◽  
Ashwani Soni ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Resonance Imaging ◽  
Posterior Tibial ◽  
Notch Width ◽  
Anterior Cruciate ◽  
Notch Width Index

Background: The relationship between anterior cruciate ligament (ACL) injury and anatomical structures is still a topic of debate. Purpose: The aim of this study was to compare knee geometry in demographically matched ACL-injured and ACL-intact athletes. Methods: We conducted a case-control study comparing 2 groups, each consisting of 55 professional athletes (44 men and 11 women): 1 group with complete ACL tears (cases) and 1 group with intact ACLs (controls). The groups were compared using magnetic resonance imaging (MRI) in terms of intercondylar notch geometry, tibial plateau characteristics, and ACL volume. Results: Among cases and controls, we found the cases had lower notch width (20.24 ± 2.68 mm vs. 22.04 ± 2.56 mm, respectively) and notch width index (0.29 ± 0.03 vs. 0.31 ± 0.03, respectively). The mean ACL volume in the cases (1181.63 mm3 ± 326 mm3) was also lower than in controls (1352.61 mm3 ± 279.84 mm3). The parameters of tibial slope geometry were comparable between groups. In addition, women had lower ACL volume than men (1254 ± 310 mm3 vs. 890 ± 267 mm3, respectively) and higher medial posterior tibial slope (4.76 ± 2.6 vs. 6.63 ± 1.83, respectively). Among cases, women had narrower notch width than men (16.9 ± 2.42 mm vs. 21.08 ± 2.03 mm). However, notch width index was comparable between male (0.3 ± 0.02) and female (0.28 ± 0.03) cases. Conclusion: Our findings suggest that narrow notch width and low ACL volume may enhance the risk of ACL injury among athletes. There was no association found between posterior tibial slope and ACL injury between athletes with injured ACLs and controls. Further study is indicated.

Differences in Medial and Lateral Posterior Tibial Slope: An Osteological Review of 1090 Tibiae Comparing Age, Sex, and Race

2016 ◽  
Vol 45 (1) ◽  
pp. 106-113 ◽  
Author(s):  
Douglas S. Weinberg ◽  
Drew F.K. Williamson ◽  
Jeremy J. Gebhart ◽  
Derrick M. Knapik ◽  
James E. Voos
Keyword(s):  
Cruciate Ligament ◽  
Tibial Slope ◽  
Axial Rotation ◽  
Posterior Tibial Slope ◽  
Normative Values ◽  
Tibial Rotation ◽  
Level Of Evidence ◽  
Posterior Tibial ◽  
Lateral Posterior ◽  
The Mean

Background: Injuries to the anterior cruciate ligament (ACL) are common, and a number of knee morphological variables have been identified as risk factors for an ACL injury, including the posterior tibial slope (TS). However, limited data exist regarding innate population differences in the TS. Purpose: To (1) establish normative values for the medial and lateral posterior TS; (2) determine what differences exist between ages, sexes, and races; and (3) determine how internal or external tibial rotation (as occurs during sagittal knee motion) influences the stereotactic perception of the TS. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 545 cadaveric specimens (1090 tibiae) were obtained from the Hamann-Todd osteological collection. Specimens were leveled in the coronal, sagittal, and axial planes using a digital laser. Virtual representations of each bone were created with a 3-dimensional digitizer apparatus. The TS of the medial and lateral tibial plateaus were measured using techniques adapted from previous radiographic protocols. Medial and lateral TS were then again measured on 200 tibiae that were internally and externally rotated by 10° (axially). Results: The mean (±SD) medial TS was 6.9° ± 3.7° posterior, which was greater than the mean lateral TS of 4.7° ± 3.6° posterior ( P < .001). Neither the medial nor lateral TS changed with age. Women had a greater mean TS compared with men on both the medial (7.5° ± 3.8° vs 6.8° ± 3.7°, respectively; P = .03) and lateral (5.2° ± 3.5° vs 4.6° ± 3.5°, respectively; P = .04) sides. Black specimens had a greater mean medial TS (8.7° ± 3.6° vs 5.8° ± 3.3°, respectively; P < .001) and lateral TS (5.9° ± 3.3° vs 3.8° ± 3.5°, respectively; P < .001) compared with white specimens. Axial rotation was shown to increase the perception of the medial and lateral TS ( P < .001). Conclusion: The medial TS was shown to be greater than the lateral TS. Important sex- and race-based differences exist in the TS. This study also highlights the role of axial rotation in measuring the TS.

Change in Posterior Tibial Slope in Skeletally Immature Patients With Anterior Cruciate Ligament Injury: A Case Series With a Mean 9 Years’ Follow-up

2021 ◽  
pp. 036354652199709
Author(s):  
R. Kyle Martin ◽  
Guri R. Ekås ◽  
JūratėŠaltytė Benth ◽  
Nicholas Kennedy ◽  
Gilbert Moatshe ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Tibial Slope ◽  
Posterior Tibial Slope ◽  
Skeletally Immature ◽  
Posterior Tibial ◽  
Lateral Posterior ◽  
The Mean ◽  
Injured Knee

Background: Increased lateral posterior tibial slope (LPTS) is associated with increased rates of anterior cruciate ligament (ACL) injury and failure of ACL reconstruction. It is unknown if ACL deficiency influences the developing proximal tibial physis and slope in skeletally immature patients through anterior tibial subluxation and abnormal force transmission. Purpose: To assess the natural history of LPTS in skeletally immature patients with an ACL-injured knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 38 participants from a previous study on nonoperative management of ACL injury in skeletally immature patients were included. During the initial study, bilateral knee magnetic resonance imaging (MRI) was performed within 1 year of enrollment and again at final follow-up. All patients were younger than 13 years at the time of enrollment, and final follow-up occurred a mean 10 years after the injury. MRI scans were retrospectively reviewed by 2 reviewers to determine bilateral LPTS for each patient and each time point. Linear mixed models were used to assess LPTS differences between knees, change over time, and association with operational status. Subgroup analyses were performed for patients who remained nonoperated throughout the study. Results: A total of 22 patients had ACL reconstruction before final follow-up and 16 remained nonoperated. In the entire study population, the mean LPTS was higher in the injured knee than in the contralateral knee at final follow-up by 2.0° ( P < .001; 95% CI, 1.3°–2.6°). The mean LPTS increased significantly in the injured knee by 0.9° ( P = .042; 95% CI, 0.03°–1.7°), while the mean LPTS decreased in the contralateral knee by 0.4° ( P = .363; 95% CI, –0.8° to 0.4°). A significant difference in LPTS was also observed in the nonoperated subgroup. No significant association was observed between LPTS and operational status. Conclusion: Lateral posterior tibial slope increased more in the ACL-injured knee than in the contralateral uninjured knee in a group of skeletally immature patients. Lateral posterior tibial slope at baseline was not associated with the need for surgical reconstruction over the study period.

Computed tomographic evaluation of the canine intercondylar notch in normal and cruciate deficient stifles

2008 ◽  
Vol 21 (02) ◽  
pp. 119-124 ◽  
Author(s):  
D. A. Allen ◽  
T. D. Henrikson ◽  
T. W. Lehenbauer ◽  
B. A. Lewis
Keyword(s):  
Normal Population ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Ligament Injury ◽  
Intercondylar Notch ◽  
Cranial Cruciate Ligament ◽  
Notch Angle ◽  
Notch Width ◽  
Orthopaedic Literature ◽  
Notch Width Index

SummaryIn the human and veterinary orthopaedic literature it has been implied that intercondylar notch stenosis is a mechanical factor in cranial cruciate ligament rupture and intraarticular graft failure. The patients in this study were classified as normal (32), unilateral cruciate rupture (23), or bilateral cruciate rupture (17). The dogs were placed under general anaesthesia and both stifles were scanned via computed tomography (CT) as previously described. Three CT slices at predetermined levels were evaluated within the notch. Measurements included opening notch angle, notch width and height, condyle width, and notch width index (notch width/ condyle width) at two different heights within the notch. Intercondylar notch measurements at the most cranial extent were significantly more narrow in unilateral and bilaterally affected stifles when compared to the normal population. Significant differences were noted in the opening notch angle (ONA), notch width index (NWI), NWI at two thirds notch height (NWI2/3), and tibial slope index (TSI). No significant differences were noted between unilateral and bilateral affected stifles. Increased mechanical contact of the cranial cruciate ligament with a stenotic intercondylar notch may predispose the ligament to mechanical wear and structural weakening. Intercondylar notch measurements have been used as a tool to predict the risk of anterior cruciate ligament injury in young human athletes, and to assess the risk factors for intra-articular graft replacements. Our findings may be useful in developing similar predictive models using stifle CT scans.

scholarly journals Lower Limb Alignment in Anterior Cruciate Ligament–Deficient versus –Intact Knees

2011 ◽  
Vol 19 (3) ◽  
pp. 303-308 ◽  
Author(s):  
Stephen Chor-Yat Chung ◽  
Wai-Lam Chan ◽  
Sze-Hung Wong
Keyword(s):  
Anterior Cruciate Ligament ◽  
Lower Limb ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Acl Injuries ◽  
Neck Shaft Angle ◽  
Notch Width ◽  
Anterior Cruciate ◽  
Acl Deficient ◽  
Notch Width Index

Purpose. To compare anatomic lower limb features of anterior cruciate ligament (ACL)–deficient versus –intact knees in Chinese subjects. Methods. Anatomic lower limb features (mechanical axis, tibiofemoral angle, posterior tibial slope, notch width index, and hip neck-shaft angle) of 25 men and 3 women aged 18 to 39 (mean, 26) years with ACL-deficient knees, and 16 men and 4 women aged 24 to 31 (mean, 28) years with ACL-intact knees were compared using radiography. Results. The notch width index (0.26 vs. 0.29, p=0.02) was significantly smaller in ACL-deficient than ACL-intact knees. Conclusion. Small notch width was associated with a thin ACL and can be regarded as an anatomic intrinsic risk factor for ACL injuries.

scholarly journals Lateral Posterior Tibial Slope in Male and Female Athletes Sustaining Contact Versus Noncontact Anterior Cruciate Ligament Tears: A Prospective Study

2019 ◽  
Vol 47 (8) ◽  
pp. 1825-1830 ◽  
Author(s):  
Nicholas N. DePhillipo ◽  
Connor G. Zeigler ◽  
Travis J. Dekker ◽  
W. Jeffrey Grantham ◽  
Zachary S. Aman ◽  
...  
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Mechanism Of Injury ◽  
Resonance Imaging ◽  
Male And Female ◽  
Acl Tear ◽  
Posterior Tibial ◽  
Lateral Posterior ◽  
Anterior Cruciate

Background: Lateral posterior tibial slope (PTS) has been identified as a risk factor for primary anterior cruciate ligament (ACL) tears. Purpose/Hypothesis: The purpose was to prospectively determine if there was a difference in lateral PTS between male and female athletes sustaining contact ACL tears as compared with a group of sex-, age-, and activity-matched athletes who sustained noncontact ACL tears. It was hypothesized that there would be no difference in degree of lateral PTS between contact and noncontact mechanisms among patients sustaining primary ACL tears in sports. Study Design: Cohort study; Level of evidence, 3. Methods: Data from patients who underwent primary ACL reconstruction without posterior cruciate ligament injury between 2016 and 2018 by a single surgeon were prospectively analyzed. Measurements of lateral PTS were performed on magnetic resonance imaging. Mean values of lateral PTS were compared between the ACL tear groups. Additionally, a group of patients with intact knee ligaments were matched to patients with ACL tears to serve as controls. Results: A total of 245 patients had complete primary ACL tears during the inclusion period. Of these, 56 (23%) reported a contact mechanism of injury at the time of ACL tear, and 56 patients who sustained noncontact ACL tears were matched to the contact ACL tear group. There were no significant differences in sex ( P≥ .999), age ( P = .990), or body mass index ( P = .450) between the patient groups. The mean lateral PTS was 9.1°± 2.9° for the ACL contact and 9.9°± 3.0° for the ACL noncontact group ( P = .180). There was a significant difference in mean lateral PTS between the ACL tear groups (noncontact and contact: 9.5°± 3.0°) and matched control group (5.6°± 1.9°, P = .0001). Conclusion: The lateral PTS was significantly increased among patients with contact and noncontact ACL tears as compared with controls. However, there were no differences in lateral PTS between patients who sustained contact and noncontact ACL tears. Lateral PTS measured on magnetic resonance imaging does not appear to be predictive of the mechanism of injury type among patients who sustain a contact or noncontact primary ACL tear.

scholarly journals Femoral notch and proximal tibial morphology and their relationship with an anterior cruciate ligament injury in the Indian population: A magnetic resonance imaging-based study

2020 ◽  
Vol 1 ◽  
pp. 193-198
Author(s):  
Vishal Huggi ◽  
K. Yogesh ◽  
George Jacob ◽  
Shailesh Pai ◽  
Ajith Kumar ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Resonance Imaging ◽  
Posterior Tibial ◽  
Lateral Posterior ◽  
Anterior Cruciate

Objectives: We aim to study the incidence of anterior cruciate ligament (ACL) injury to proximal tibia bone morphology in Indian patients. Materials and Methods: Forty male subjects who sustained non-contact ACL injury who presented to our center between October 2015 and December 2016 studied and compared to 40 non-ACL injury knee magnetic resonance imaging scans. Notch morphology and both medial and lateral posterior tibial slope measurements were performed and studied. Results: We noted that the difference in notch depth and notch angle between the two groups was not significant. There was a statistically significant higher incidence of ACL injury in patients with smaller notch widths. Both an increased medial and lateral posterior tibial slope did not demonstrate a statistically significant incidence in ACL injury. Conclusion: Notch width is a major contributing risk factor for ACL injury in Indian patients. This is in agreement with previously published literature.

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