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<p><b>Background:</b>Identification of the proper femoral intramedullary (IM) access point is an important determinant of final implant position in IM-guided total knee arthroplasty (TKA). The aim of this study was to identify the optimal entry point in Chinese participants using a new three-dimensional method.</p><p><b>Methods:</b>A series of computed tomography scans of 44 femurs in Chinese participants from October 2014 to October 2015 were imported into Mimics 17.0 software to identify the optimal entry point. The apex of the intercondylar notch (AIN) was used as the reference bony anatomical landmark to identify the proper entry point to insert the IM rod. The statistical significance was calculated on the basis of a 5% level (P < 0.05) using the Student's t-test.</p><p><b>Results:</b>For the males, the average ideal entry point was 1.49 mm medial and 13.39 mm anterior to the AIN. The values were 1.77 mm medial and 15.29 mm anterior to the AIN in females. A significant difference was present between males and females (13.39 ± 2.46 mm vs. 15.29 ± 3.44 mm, t = 2.124, P = 0.040). When using the recommended location as the entry point for the IM rod, the mean potential error differed significantly from the femoral trochlear groove (the potential error of IM in males in coronal plane: 0.93° ± 0.24° vs. 1.27° ± 0.32°, t = -4.166, P <0.001; the potential error of IM in males in sagittal plane: 1.40° ± 0.42° vs. 2.79° ± 0.70°, t = 7.155, P < 0.001; the potential error of IM in females in coronal plane: 0.73° ± 0.28° vs. 1.15° ± 0.35°, t = 3.940, P < 0.001; and the potential error of IM in females in sagittal plane: 1.48° ± 0.47° vs. 2.76° ± 0.83°, t =5.574, P < 0.001). A significant difference was present between the recommended point and the point 10 mm anterior to the origin of the posterior cruciate ligament (the potential error of IM in males in coronal plane: 0.93° ± 0.24° vs. 1.53° ± 0.43°, t = 5.948, P < 0.001; the potential error of IM in males in sagittal plane: 1.40° ± 0.42° vs. 2.15° ± 0.75°, t = 3.152, P = 0.003; the potential error of IM in females in coronal plane: 0.73° ± 0.28° vs. 1.28° ± 0.42°, t = -4.632, P < 0.001; and the potential error of IM in females in sagittal plane: 1.48° ± 0.47° vs. 2.40° ± 0.93°, t = 3.763, P = 0.001).</p><p><b>Conclusions</b>The technique described here is an innovative method for swift, easy, and accurate access to the medullary canal during TKA, and it can optimize the position and orientation of the prosthetic components in knee arthroplasty.</p>
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The intercondylar notch has been an anatomic site of interest as it lodges the anterior cruciate ligament. The objectives of the present study were to study the morphology and morphometry of femoral intercondylar notch in cadaveric dry bones with emphasis on its clinical implications.The present investigation was performed by using 97 dry femora. The parameters like intercondylar notch width, intercondylar notch depth, condylar width and condylar depth were measured. The shapes of intercondylar notch were also analyzed. The measurements were compared statistically with respect to right and sides and were tabulated. It was observed that the intercondylar notch was having inverted ‘U’ shape morphology in 71 (73.2%) specimens and it was inverted ‘V’ shaped in 26 (26.8%) cases. The mean intercondylar notch width, intercondylar notch depth, condylar width and condylar depth were 11.9 ± 2.7 mm, 26.3 ± 2.4 mm, 72.9 ± 5.3 mm and 57.3 ± 4.3 mm, respectively. It was observed that there was no statistical significance difference observed (p > 0.05) between the right and left sides. The notch width index and notch depth index were determined as 0.25 and 0.46, respectively. The morphometry data of the present study could provide importance to the orthopedicians in prevention and management of knee injuries. We believe that the present study has provided additional information on this subject and these data might be of use to the clinicians who are involved in the diagnosis and management of knee problems.
Subject(s)
Anterior Cruciate LigamentABSTRACT
PURPOSE: The aim of this study was to evaluate the correlation between the 3-dimensional (D) notch volume and the 2D notch width and notch shape as measured on magnetic resonance imaging (MRI), between subjects with anterior cruciate ligament (ACL) injury and those without ACL injury. MATERIALS AND METHODS: Knee MRI images were taken from 72 subjects with ACL injury and 80 subjects without ACL injury (January 2007 to January 2012; Gyeongsang National University Hospital, Jinju, Korea). We measured 3D notch volume and 2D notch width and notch shape. The measured values from MRI figures between ACL-injured subjects and non-ACL-injured subjects were compared and analyzed. These measurements (notch width, notch ratio) were correlated to notch volume. Both intra-observer reliability and inter-observer reliability were calculated. RESULTS: Notch width differed significantly between ACL injured subjects and non-injured subjects (p<0.001), while no significant differences in notch volume and notch shape were observed between the groups (male: p=0.43, female: p=0.22). CONCLUSION: The results of this study might suggest that certain 2D measurements (notch width) of the notch could be better than notch volume for prediction of ACL rupture risk.
Subject(s)
Female , Humans , Anterior Cruciate Ligament , Knee , Magnetic Resonance Imaging , RuptureABSTRACT
ObjectiveTo investigate clinical efficacy of reconstructing for old anterior cruciate ligament(ACL) injury with quadruple hamstring tendon,and application value of femoral intercondylar notch plasty.Methods Fifty-six cases of old ACL injury were reconstructed arthroscopically with quadruple hamstring tendon.Forty-five cases were used femoral intercondylar notch plasty.Preoperative Lachman test were positive,and ACL injury were confirmed by MRI.The curative effect was evaluated according to Lysholm knee score and KT-1000 measurement results.ResultsAll of the 56 patients were followed up for 6-24 (13.0 ± 4.2) months.Postoperative Lachman test of 53 cases were negative,and 3 cases were weak positive.The Lysholm knee score increased from preoperative (56.0 ± 7.3) scores to postoperative (93.0 ± 3.5 ) scores,comparison of preoperative had significant difference (t =34.20,P ＜ 0.01 ).The postoperative KT-1000 measurement showed ＜ 3.0 mm side difference of anterior laxity,moving average of(2.0 ± 0.6) mm,comparison of preoperative ≥ 3.0 mm,moving average of (3.0 ± 1.2 ) mm had significant difference (t =5.58,P ＜ 0.01 ).ConclusionsArthroscopic reconstruction of ACL with quadruple hamstring tendon have a good effect.The postoperative rehabilitation exercise can practise early.The femoral intercondylar notch plasty which used during operation is benefit of decreasing femoral intercondylar notch impingement syndrome,accurate positioning femur tunnel,and increasing curative effect.
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Determinaram-se os índices de largura da fossa intercondilar (FI), após transecção do ligamento cruzado cranial em nove cães adultos submetidos à estabilização articular com retalho de fáscia lata. Os joelhos foram alocados em dois grupos, sendo o joelho direito (GI) submetido à incisuroplastia troclear (ITR) e posterior estabilização articular, e o joelho esquerdo submetido somente à substituição ligamentar (GC). Cada grupo foi dividido em três subgrupos correspondentes aos momentos de eutanásia aos 30, 90 e 180 dias de pós-operatório. Os índices de largura da FI foram determinados, macroscópica e radiograficamente, pela mensuração da abertura cranial da FI nos terços cranial, médio e caudal, e indexados em relação à largura epicondilar. Observou-se aumento significativo dos índices macroscópicos e radiográficos nas articulações do GI, sendo estes estatisticamente diferentes daqueles das articulações de GC. Não foi observada estenose intercondilar nos joelhos de GC após a estabilização articular. Conclui-se que a estabilização articular com retalho de fáscia lata preveniu a estenose da fossa intercondilar, e que a ITR promoveu o alargamento permanente dessa estrutura.
Intercondylar fossa width indexes (IFWI) were determined in nine adult dogs submitted to intercondylar notchplasty (IN) after transection of the cranial cruciate ligament (CCL) followed by a fascial strip stabilization. The right stifle was submitted to IN followed by fascial strip reconstruction of the CCL (GI) while in the left stifle IN was not performed (GC). Each group was then divided into three subgroups which corresponded to time of euthanasia at 30, 90 and 180 days after surgery. IFWI were determined, both macroscopically and radiographically, by measuring the cranial outlet of the intercondylar fossa in relation to the epicondylar width. A significant increase was observed in indexes of GI following IN, and these differed from indexes of GC throughout the evaluation period. It was concluded that articular repair using a fascia strip prevented stenosis of the intercondylar fossa, and that IN caused a permanent widening of it.
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Objective To summarize clinical features and explore diagnosis and treatment of femoral intercondylar notch non-bony impingement syndrome. Methods 15 patients of femoral intercondylar notch non-bony impingement syndrome were identified during arthroscopic operation of 115 patients (120 knees) with restricted knee joint extention during Oct 2004 to Dec 2007. Among these 15 patients, there were 3 cases of Bucket Handle Tear(BHT), 1 case of ACL's cyst, 3 cases of ACL tibial avulsion injury, 3 cases of synovial incarceration, and 5 cases of synovial chondroma. 9 patients were diagnosed by MRJ and 2 by X-ray before operation. All 15 patients were confirmed under arthroscopy. Results 15 patients( 15 knees) were operated and followed up for a period of 4～24 months, mean 13 months. Mean Lysholm score was 65(range, 41～75) before operation and 89(range, 75～100) after operation. Joint extension restrict was 5～25 degrees (mean 8.1 degree) before operation and 0 degree after operation. Conclusion Arthroscopy could accurately diagnose femoral Intercondylar notch non-bony impingement syndrome. Pre-operation MRI was helpful for diagnosis. If MRI and X-ray showed negative findings, diagnostic arthroscopic examination could be applied. Good subjective and objective effects could be achieved with arthroscopic operation.
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PURPOSE: The purpose of this study was to evaluate the relationship between the femoral intercondylar notch width (ICW), the posterior tibial slope angle (PTS), rupture of the anterior cruciate ligament (ACL) and the ruptured site. MATERIALS AND METHODS: We retrospectively reviewed 105 cases of ruptured ACL (105 patients), and 91 cases of intact ACL (91 patients). The ICW and PTS were measured from the plain knee radiographs. The ratio of the ICW and the femoral intercondylar notch height (ICH) was also measured. As for the site of ACL rupture, the patients with a ruptured ACL were divided into 3 groups (group 1: femoral attach site, 2: mid-substance, 3: tibial attach site), and the correlations between the ICW and the PTS of each group were analyzed. RESULTS: The mean ICW of the ACL ruptured group was 15.51+/-4.30 mm (95% confidence interval: 15.48~15.53), that of the ACL intact group was 24.49+/-3.86 mm (24.47~24.52), and the mean PTS of the ruptured ACL group was 7.68+/-3.78degrees (7.65~7.70) and that of the intact ACL group was 6.12+/-3.85degrees (6.10~6.13). A narrow ICW was a significant risk factors for ACL rupture (odds ratio=0.661 [0.602~0.720], p<0.01). But we did not get any statistically significant results for the increase PTS (odds ratio=1.073 [1.062~1.134], p=0.197). According to the ruptured site, the analysis of variance of the ICW and PTS had no significant correlation. CONCLUSION: A narrow ICW is a significant risk factor for ACL rupture.
Subject(s)
Humans , Anterior Cruciate Ligament , Knee , Retrospective Studies , Risk Factors , RuptureABSTRACT
PURPOSE: The purpose of this study is to evaluate the possible relationship between femoral intercondylar notch stenosis and ACL injury according to gender with retrospective analysis of knee MRI. MATERIALS AND METHODS: The study was based on 260 cases of knee MRI (except the cases of combined colleteral ligaments injury and fracture) between the ages of 18 and 50 years from March 1995 to March 2001. All cases were divided into three groups : group 1 consisted of knees 94 cases that were nor-mal, group 2 consisted of knees from 72 cases that had a contact ACL injury, group 3 consisted of knees from 92 cases that had a non contact ACL injury. We measured the notch height, notch width at the point of 1/3, 2/3 of notch height, notch angle, lateral angle with coronal section. Each measurements of three groups were compared with gender and for statistical significance using the ANOVA test. RESULTS: The mean notch angle was 48.2 +/-6.7 degrees for men and 47.1 +/-1.2 degrees for women in group 1, 48.7 +/- 6.5 degrees for men and 48.7 +/-1.2 degrees for women in group 2, 47.4 +/-6.5 degrees for men and 47.3 +/-1.5 degrees for women in group 3. The mean notch width at the point of 1/3, 2/3of notch height were 18.6 +/-2.4 mm, 15.3 +/-2.4 mm for men and 16.9 +/-2.4 mm, 14.2 +/-2.4 mm for women in group 1, 18.2 +/-2.4 mm, 15.2 +/-2.4 mm for men and 16.7 +/-2.4 mm, 13.9 +/-2.4 mm for women in group 2, 16.8 +/-2.4 mm, 13.9 +/-2.4 mm for men and 15.7 +/-2.4 mm, 13.4 +/-2.4 mm for women in group 3. Statistically significant differences were found between sexes in group 3 in regard to notch width at the point of 1/3, 2/3 of notch height, notch angle(<0.05). CONCLUSION: Stenosis of femoral intercondylar notch may be a factor of ACL injury. So preoperative measurement of femoral intercondylar notch may be necessary to determine the amount of notchplasty degree in ACL reconstruction.
Subject(s)
Female , Humans , Male , Constriction, Pathologic , Knee Joint , Knee , Ligaments , Magnetic Resonance Imaging , Retrospective StudiesABSTRACT
PURPOSE: My goal was to evaluate and summarize the results of treatment of patients with anterior cruciate ligament injury with intercondylar notch stenosis. MATERIALS AND METHODS: I reviewed the 8 anterior cruciate ligament(ACL) injuries with inte#rcondylar notch stenosis treated between November 1996 and August 1999. A study group of 8 consecutive patients underwent a magnetic resonance imaging(MRI) evaluation for unspecified knee pain and swelling. The inetrcondylar notch width were measured with MRI at the notch entrance, at the central notch. Arthro- scopic surgery in all patients was performed. RESULTS: Several patients had clinical symptoms and signs of patello femoral syndrome, unspecified synovitis, etc. that it has limited specific diagnostic value, but nobody showed motion loss of their knees or evidence of instability. MRI demonstrated intrasubstance edema of ACL impling a complete tear in sagittal image. Absolute widths at notch entrance were ranged 11 14mm in men, 10 12mm in women. At the central notch, notch widths measured 13-19mm in men and 11-16mm in women. Arthroscopic finding revealed impingement with whole notch stenosis(5 cases) or with encroachment of lateral notch wall(3 cases). ACLs of all patients were frayed, but those of 2 patients were partially torn. No chondral lesions or degenerative changes were noted. A 3-5mm notchplasty was performed to remove of bone at the anteri- or outlet of the intercondylar notch in all patients. In one patient, the MRI study performed 19 months postoperatively revealed normal ACL signal. I underwent second-look arthroscopy 2 years postoperative- ly in another one patient. The notchplasty site appeared to have minimally recorticated and ACL showed almost normal state. After 17 months of average follow-up, every clinical symptoms and signs was signif- icantly disappeared in 6 patients. On the other hand, 1 patients have intermittent pain and joint swelling over their knees and need some medicine. One of 8 patients had a tear of his ACL at 20 months after notchplasty and underwent anterior cruciate ligament reconstruction. CONCLUSTION: Although the small cases were evaluated, there was a trend that the patients with narrower notches or with encroachment of the lateral walls have abnormal clinical symptoms and signs. I believe that sufficient understanding of the disease and early performance of notchplasty with arthroscopy may prevent the possibility of complete rupture.
Subject(s)
Female , Humans , Male , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament , Arthroscopy , Constriction, Pathologic , Edema , Femur , Follow-Up Studies , Hand , Joints , Knee , Magnetic Resonance Imaging , Rupture , SynovitisABSTRACT
0.05). The notch width index was 0.24?0.05. There was no correlation between the notch width index and the height (r=-0.11), the body weight (r=-0.13), and the age (r=-0.28). Conclusion The notch-view radiographs with 45? flexion of the knee can satisfactorily show the shape and the width of the intercondylar notch. The notch width and the notch width index of the normal knee are (18.9?4.8) mm and 0.24?0.05, respectively. The height and the body weight can′t be used to predict the notch width. The study supplies the radiographic basis for the diagnosis and treatment of the diseases related with the femoral intercondylar notch.
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The purposes of this study were to document the dimensions of the intercandylar notch in the normal knee; to compare normal knee notches stenosis and femoral intercondylar roof angle to those knees with ACL tears; to compare sexual difference in normal knee to determine if there is a relationship between femoral intercondylar roof angle and notch stenosis and ACL tears. We analyzed 128 MRI of knees taken using the Signa 1.5T MR machine between the ages of 18 and 46 from Feb. 1995 to Feb. 1996. The Group 1 was ninty-one normal knees. The Group 1-F was the normal twenty-two knees of female. The Group 1-M was the normal sixty-nine knees of male. The Group 2 was thirty-seven knees with MRI and arthroscopically confirmed ACL tears within 2 months after injury. We measured the femoral intercondylar roof angle, open notch angle, ratio of notch width at two-thirds of the notch height to condylar width, and ratio of maximum notch width to condylar width from sigittal, transverse cut of MRI. The measurements of the two groups were compared for statistical significance using the student's t-test. Statistically significant differences were found between normal (Group 1) and ACL injured knees (Group 2) in regard to ratio of notch width at two-thirds of the notch height to condylar width, and ratio of maximum notch width to condylar width, but no significant differences were found in the femoral intercondylar roof angle, and open notch angle, suggesting a significant association between anterior outlet stenosis and ACL tears. And statistically significant difference was found only in the ratio of maximum notch width to condylar width between normal male (Group 1-M) and female (Group 1-F), suggesting more stenotic in male group. Although a stenotic femoral intercondylar notch may contribute to a torn ACL, the intercondylar roof angle and open notch angle does not correlate with an ACL tears.
Subject(s)
Female , Humans , Male , Constriction, Pathologic , Femur , Knee , Magnetic Resonance ImagingABSTRACT
The purpose of this retrospective study was to evaluate the morphology of the intercondylar notch of the knee in 72 anterior cruciate ligament (ACL) intact group and 30 acute and chronic ACL tear group by plain radiographs and MRI, and to find the predisposing factors of ACL tear. The ACL tear group was divided into acute and chronic ACL tear group. In plain lateral radio-graphs, beta angle, angle between extension line from anterior cortical line of distal femur and from Blumensaat s line, was measured. In magnetic resonance imaging, the width of intercondylar notch (NB), the widest width of both femoral condyle (NW), intercondylar notch width from lower one third point of notch basal line (NB1), intercondylar notch width from upper one third point of notch basal line (NB2), depth of intercondylar notch from notch basal line (ND), and intercondylar angle which made from both end point of notch basal line and apex of intercondylar notch (alpha) were measured. Three groups were compared with each other by statistical analysis. Stastistically, the acute ACL tear group had narrow upper portion of intercondylar notch than chronic ACL tear group and more acute angle of roof of the intercondylar notch than intact ACL group. So in notchplasty, the upper one-third of intercondylar notch should be carefully widened. And after fixation of femoral interference screw, arthroscopic observation should be done whether reconstruced graft touchs the roof of the intercondylar notch during the extension of the knee.
Subject(s)
Anterior Cruciate Ligament , Causality , Femur , Knee , Magnetic Resonance Imaging , Retrospective Studies , TransplantsABSTRACT
Recently MRI has been shown to be a sensitive and specific study for the noninvasive detection of meniscal tears and several MRI findings of bucket-handle meniscal tears have been reported. Therefore, the MRI findings of the menisci proven to be the bucket-handle tear with arthroscopy were evaluated and the typical MRI findings seen to be the bucket-handle meniscal tear of the knee were analysed. 76 patients with proven bucket-handle meniscal tears arthroscopically were reviewed retrospectively, in which MRI was performed in 24 patients. The 3 typical findings of bucket-handle meniscal tears were assessed: double PCL (posterior cruciate ligament) sign, flipped meniscus sign, and fragment in the intercondylar notch. In 245 cases of meniscus tears, bucket-handle meniscal tears were 76 cases (31.0%) with 52 cases at medial meniscus and 24 cases at lateral meniscus. As to clinical and physical findings of the bucket-handle meniscal tears, McMurray test, locking, joint line tenderness and giving way sense were presented in orders. The sites of bucket-handle meniscal tear were medial meniscus in 17 cases and lateral in 7 cases. The double PCL sign was seen in 10 cases (58.8%) of in medial bucket-handle meniscal tears and in 3 cases (42.9%) of 7 lateral bucket-handle meniscal tears. The flipped meniscus sign were seen in 3 cases (17.6%) of medial bucket-handle meniscal tears and in 3 cases (42.9 %) of lateral bucket-handle meniscal tears. Fragments were identified in the intercondylar notch in 8 cases (47.1%) of medial bucket-handle meniscal tears and in 3 cases (42.9%) of lateral bucket-handle meniscal tears. There were 19 cases (79.2%) in which at least one or more typical findings were presented on MR images. The MRI is a sensitive study for detection of bucket-handle meniscal tears but precise interpretation of MRI is needed for diagnosis of bucket-handle tears. In this respect, the above three typical findings are helpful and reproducible for diagnosis of bucket-handle meniscal tears with MR images; double PCL sign, fragment in the intercondylar notch and flipped meniscus sign.