Femoral Intercondylar Notch Stenosis and Correlation to Anterior Cruciate Ligament Injuries

Abstract

To evaluate the possible relationship between femoral intercondylar notch stenosis and anterior cruciate ligament injuries in pivoting and cutting sports, a 2-year prospective study was performed on intercollegiate athletes at a Division I university. Daily practice times and athlete participation in practices and games were recorded for each sport during the 2-year period. Bilateral intercondylar notch view radiographs were taken of all athletes enrolled in the study. The notch width index, a ratio that measures the width of the anterior outlet of the intercondylar notch divided by the total condylar width at the level of the popliteal groove, was measured for each knee. A total of 213 athletes, representing 415 anterior cruciate ligament-intact knees, were enrolled in the study. There were 7 anterior cruciate ligament tears. Statistical analysis demonstrated a correlation between femoral intercondylar notch stenosis and anterior cruciate ligament injuries. No statistical difference was found between the sex of the athlete and notch width indices or rate of anterior cruciate ligament tears. Athletes with intercondylar notch stenosis appear to be at increased risk for noncontact anterior cruciate ligament injuries.

Risk factors for Anterior Cruciate Ligament injury in skeletally immature patients: analysis of intercondylar notch width using Magnetic Resonance Imaging

“…Our finding that a lower NWI index may predispose to ACL injury in the paediatric population is in accordance with previous studies looking at young adult populations [2][3][4][5][6][7]20]. While there is still disagreement in the literature as to whether variations in notch geometry related to differences in gender or limb dominance, play a contributing role in ACL injuries, we did not find a difference in NWI with respect to gender, involved side, mechanism of injury or type of sport engaged in at the time of injury [7,12,13,18,21,22].…”

“…This difference may be caused by different imaging techniques used for the evaluation of NWI. Two studies measuring NWI using MRI [8,21] have shown much higher values for normal adult populations than values reported in radiographic studies [2][3][4][5][6][7]20].…”

“…When provided, the mean values recorded in an ACLdeficient adult population using plain radiographic studies were 0.22 [3] and 0.23 [6], respectively. The lowest values of NWI in an ACL-deficient group were presented by Uhorchak et al [7] who, after analysis of 24 knees of West Point cadets with ACL injury, noted a mean NWI measuring 0.18.…”

“…Souryal and Freeman [6] found a correlation between intercondylar notch stenosis and bilateral injury of the ACL, and described a method of measurement of intercondylar notch width, the notch width index (NWI), on plain tunnel-view radiographs. In the literature the majority of studies suggest that lower values of NWI are associated with a higher risk of ACL injury [2][3][4][5][6][7]. Others, however, did not find significant differences between notch measurements of the uninjured population and subjects with ACL tears [8][9][10].…”

“…Since that time, several authors have evaluated the role of a narrow intercondylar notch as a risk factor for acute ACL injury. While the majority of studies do suggest that notch stenosis is associated with a higher risk of ACL injury [2][3][4][5][6][7], others did not find significant differences between notch measurements of uninjured athletes and subjects with ACL tears [8][9][10]. We know of only one report focussing on the notch width in a paediatric population [11].…”