Intercondylar notch width and the risk for anterior cruciate ligament rupture: A case-control study in 46 female handball players

Abstract

We measured the intercondylar notch of the femur in female handball players from radiographs of 20 players with previous unilateral anterior cruciate ligament injury, and 26 controls without injury. The groups were comparable regarding age, height, weight and level of performance. Intercondylar fossa radiographs were obtained in a posteroanterior axial position. The anterior opening of the intercondylar notch was narrower in the healthy knee of the injured group compared to the controls. There was an increased risk of anterior cruciate ligament injury associated with decreasing notch opening: female handball players with 17 mm or less anterior notch width were 6 times more susceptible to anterior cruciate ligament injury compared to players with wider notch width.

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].…”

“…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].…”

“…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. LaPrade et al [2] reported a NWI of 0.19 among university athletes with ACL rupture. Souryal et al suggested that notch stenosis below 0.2 increases the risk of bilateral ACL injury [12] and is associated with non-contact mechanisms of ACL rupture [6].…”

“…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].…”