The Notch of Harty (Pseudodefect of the Tibial Plafond): Frequency and Characteristic Findings at MRI of the Ankle

Boutin, Robert D.; Chang, Jennifer; Bateni, Cyrus; Giza, Eric; Wisner, Erik R.; Yao, Lawrence

doi:10.2214/ajr.14.14012

Cited by 10 publications

(12 citation statements)

References 19 publications

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“…Our findings indicate that the notch of Harty is present approximately equally in both genders (male and female). This is in accordance with what has been documented by Boutin et al [7]. The authors found no sex The characteristics finding of the notch in our study is comparable to the previous study [7] identifying similar measures of the notch such as its width and depth.…”

Section: Discussionsupporting

confidence: 94%

“…Ray et al [8] also reported higher percentage of the presence of notch of Harty that found by direct anatomical inspection. This might suggest that the percentages of MRI findings of the notch is less than to what is found by direct inspection [7].…”

Section: Discussionmentioning

confidence: 78%

“…However, other previous studies reported higher incidence of the notch of Harty. For instance, Boutin et al [7] found this anatomic feature among 45% on routinely performed MRI investigations. Ray et al [8] also reported higher percentage of the presence of notch of Harty that found by direct anatomical inspection.…”

Section: Discussionmentioning

confidence: 98%

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An Observational Study of Pseudodefect of Tibial Plafond (Incidence, Characteristics and Different Parametric Correlations)

Ahmed¹,

Rashid²

2022

DJM

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Background: The notch of Harty is a normal variant radiologically and incidentally diagnosed finding but can be mistaken as pathology. Objective: To identify the incidence and characteristic findings of the notch of Harty.Patients and Methods: A cross-sectional study was conducted on 121 patients referred to the Radiology department, MRI unit, to undergo ankle MRI through a one-year period (January to December 2020). Cases with significant ankle lesions were excluded. All MRI studies were performed on 1.5 T MR scanners (Aera, Siemens, Arlington).Results: The notch of Harty was present in 35.5% patients; their age ranged from 5-83 years with a mean age of 38.20 years. The average width of the notch was 5.65mm while the mean depth was 1.04 mm. There was no significant correlation between the presence of the notch of Harty and findings such as rheumatic arthritis, minor trauma, chondral thinning. However, there was significant correlation between the presence of the notch of Harty and subjacent subchondral sclerosis. Conclusion: The notch of Harty was present among a considerable number of cases with no sex predominance. The notch might be misinterpreted by radiologists as true osteochondral lesions, thus, familiarity with location and appearance of these pseudodefects will avoid their misinterpretation. Keywords: The notch of Harty, pseudodefects, MRI, tibial plafond, osteochondral lesions

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 78%

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An Observational Study of Pseudodefect of Tibial Plafond (Incidence, Characteristics and Different Parametric Correlations)

Ahmed¹,

Rashid²

2022

DJM

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“…2 Conversely, anatomic variations such as the notch of Harty can potentially improve the safety of arthroscopic instrumentation and accessibility during ankle arthroscopy. 5 The notch of Harty was originally described as a 3- to 5-mm anteromedial recess of the distal tibial plafond and can be found in 45% to 77% of patients. 5,16,26 A posteromedial notch can also be found in 13% of the population.…”

Section: Discussionmentioning

confidence: 99%

“…5 The notch of Harty was originally described as a 3- to 5-mm anteromedial recess of the distal tibial plafond and can be found in 45% to 77% of patients. 5,16,26 A posteromedial notch can also be found in 13% of the population. 26 Although not widely used during arthroscopic treatment of OLTPs, other studies have shown that additional accessibility can be achieved with the use of arthrotomies and malleolar osteotomies.…”

Section: Discussionmentioning

confidence: 99%

Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond

et al. 2017

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Most elite athletes return to preinjury competitive activity after surgical treatment for medial malleolus stress fractures

Ramsodit,

Zwiers,

Dalmau‐Pastor

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo provide return‐to‐performance outcomes after surgical treatment for medial malleolus stress fractures in the elite athlete. Additionally, to describe an individualised surgical approach in the management of medial malleolus stress fractures.MethodsFive athletes (six ankles) underwent surgical treatment for a medial malleolus stress fracture. The surgical technique was based on the extent of the fracture line in steps with first arthroscopic debridement of bony spurs, microfracturing of the fracture line and screw fixation. Return‐to‐performance data included time to return to sport‐specific training, normal training, first competitive activity, performance and the return‐to‐performance rate.ResultsPatients returned to sport‐specific training at a median of 10 weeks. They started normal training at 16 weeks postoperatively and returned to their first competitive activity after 19 weeks. All patients had bony spurs on the distal tibia which were arthroscopically debrided. One patient received arthroscopic debridement of bony spurs alone. Four patients received additional microfracturing of the fracture line and three patients received screw fixation. All patients achieved clinical and radiographic union on follow‐up computed tomography scan at 3 months postsurgery. At latest follow‐up, no refractures nor hardware complications, nor any other complications were observed.ConclusionArthroscopic debridement of bony spurs, debridement and microfracturing of the fracture line and screw fixation are all viable surgical tools in the management of medial malleolus stress fractures in elite athletes. The surgical approach containing these options should be tailored to the individual athlete based on the fracture line in the sagittal plane. While most athletes return to full competitive activity in 3–4 months, time to self‐reported return to full performance is often much longer.Level of EvidenceLevel IV.

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The Notch of Harty (Pseudodefect of the Tibial Plafond): Frequency and Characteristic Findings at MRI of the Ankle

Abstract: The notch of Harty can be observed as an anatomic variant on MRI and should be differentiated from a traumatic osteochondral lesion.

Cited by 10 publications

References 19 publications

An Observational Study of Pseudodefect of Tibial Plafond (Incidence, Characteristics and Different Parametric Correlations)

An Observational Study of Pseudodefect of Tibial Plafond (Incidence, Characteristics and Different Parametric Correlations)

Effect of Ankle Position and Noninvasive Distraction on Arthroscopic Accessibility of the Distal Tibial Plafond

Most elite athletes return to preinjury competitive activity after surgical treatment for medial malleolus stress fractures

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