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Brochard D, Marot V, Cuvillier M, Ripoll T, Bérard E, Cavaignac E. Lateral femoral chondral lesions are more frequent when an anterior cruciate ligament tear is concomitant with a lateral femoral notch sign, but do not progress over time. Orthop Traumatol Surg Res 2024; 110:103712. [PMID: 37865237 DOI: 10.1016/j.otsr.2023.103712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/15/2023] [Accepted: 05/30/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND The lateral femoral notch sign (LFNS) is caused by an impact to the lateral femoral condyle during a pivot shift injury and affects 25% to 33% of patients with an anterior cruciate ligament (ACL) rupture. The primary aim of this study was to compare the incidence of chondral lesions 1year after ACL reconstruction, while taking into consideration preoperative chondral damage, in patients with and without a preoperative LFNS. The primary outcome measure was the presence of chondral lesions involving the lateral femoral condyle, confirmed on magnetic resonance imaging (MRI) using the Outerbridge classification, at 1year postoperative. The secondary outcome measures were bone bruise of the lateral femoral condyle confirmed on MRI, the International Knee Documentation Committee (IKDC), Lysholm and Tegner functional scores taken 1year after surgery. METHODS Sixty patients were included-30 with preoperative LFNS and 30 without-in a retrospective, comparative study of prospectively collected data on patients operated between August 2018 and December 2020. RESULTS A lateral femoral chondral lesion 1year after surgery was significantly more common in the group with a preoperative LFNS (37% [n=11] versus 13% [n=4] in the group without a preoperative LFNS, p=0.036). Adjusting the statistical analysis for preoperative body mass index (BMI) did not impact these results (adjusted odds ratio [OR]=3.83 [95%CI: 1.03-14.24]; p=0.045). Adjusting for a preoperative lateral femoral chondral lesion had an impact on these results (adjusted OR=0.78 [95%CI: 0.12-5.08]; p=0.793). This indicates that a preoperative LFNS is not significantly and independently associated with a lateral femoral chondral lesion at 1year postoperative when the analysis is adjusted for a preoperative lateral femoral chondral lesion. However, having a preoperative lateral femoral chondral lesion is significantly correlated with the presence of a lateral femoral chondral lesion 1year after the surgery (adjusted OR=63.31 [95%CI: 5.94-674.8]; p=0.001). There were no significant differences in terms of bone bruise on MRI (p=1.0), or for the IKDC (p=0.310), Lysholm (p=0.416) and Tegner (p=0.644) functional scores. The LFNS was still present in 21 out of 30 patients (70%) at 1year postoperative. The preoperative LFNS was significantly smaller in the group without a chondral lesion compared to the group with a chondral lesion 1year after the surgery (median=2.30mm [IQR: 1.40; 3.00] versus 3.10mm [IQR: 2.50; 3.40]; p value=0.045). CONCLUSIONS Patients with a preoperative LFNS are three times more likely to have a chondral lesion in the notch region 1year after surgery. These chondral lesions are concomitant to the injury and do not progress over time. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Damien Brochard
- Musculoskeletal Institute, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, Toulouse, France
| | - Vincent Marot
- Orthopaedics unit, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Marianne Cuvillier
- Musculoskeletal Institute, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, Toulouse, France
| | - Thomas Ripoll
- Musculoskeletal Institute, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, Toulouse, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR 1295 CERPOP, University of Toulouse, INSERM, UPS, Toulouse University Hospital (CHU), Toulouse, France
| | - Etienne Cavaignac
- Musculoskeletal Institute, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, Toulouse, France.
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Mostowy M, Ruzik K, Ebisz M, LaPrade RF, Malinowski K. Impaction Fractures of the Lateral Femoral Condyle Related to Anterior Cruciate Ligament Injury: A Scoping Review Concerning Diagnosis, Prevalence, Clinical Importance, and Management. Clin Orthop Surg 2023; 15:781-792. [PMID: 37811510 PMCID: PMC10551676 DOI: 10.4055/cios22278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 10/10/2023] Open
Abstract
Background During pivot-shift anterior cruciate ligament (ACL) injury, bone bruises or impaction fractures of the lateral femoral condyle (LFC-IF) may occur due to impaction between the posterior part of the lateral tibial plateau and anterocentral part of the LFC. The purpose of the study was to systematically review the literature concerning the diagnosis, prevalence, clinical importance, and management of LFC-IF occurring during ACL injuries. Methods Included were studies concerning impaction fractures of the anterocentral part of the LFC occurring during ACL injuries. Studies concerning only bone bruises or cartilage lesions, without subchondral bone impaction, were not included. A search was performed in Medline and Scopus databases, with final search in May 2022. A secondary search was conducted within the bibliographies of included articles and using "Cited In" option. Two authors independently extracted data in three domains: study design, LFC-IF characteristics, and LFC-IF importance and management. Results A total of 35 studies were included for review with several studies reporting on multiple domains. Summarily, 31 studies were on the diagnosis and prevalence, 19 studies reported on the clinical importance, and 4 studies reported on the management of LFC-IF. Conclusions A LFC-IF occurs due to the pivot-shift mechanism of ACL injury. Its radiological feature is defined as an impaction of terminal sulcus deeper than 1 mm and is present in up to 52% of patients with a torn ACL. An LFC-IF causes injury to the cartilage, probably leads to its progressive degeneration, and is significantly associated with an increased risk of a lateral meniscus injury. A large LFC-IF might be associated with greater rotational knee instability. Although several techniques of LFC-IF treatment were proposed, none of them has been evaluated on a large cohort of patients to date.
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Affiliation(s)
- Marcin Mostowy
- Orthopedic and Trauma Department, Veteran's Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Michał Ebisz
- Artromedical Orthopaedic Clinic, Belchatow, Poland
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Lehtovirta S, Casula V, Haapea M, Nortunen S, Lepojärvi S, Pakarinen H, Nieminen MT, Lammentausta E, Niinimäki J. Assessment of articular cartilage of ankle joint in stable and unstable unilateral weber type-B/SER-type ankle fractures shortly after trauma using T2 relaxation time. Acta Radiol Open 2023; 12:20584601231202033. [PMID: 37779823 PMCID: PMC10540593 DOI: 10.1177/20584601231202033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Background Early detection of post-traumatic cartilage damage in the ankle joint in magnetic resonance images can be difficult due to disturbances to structures usually appearing over time. Purpose To study the articular cartilage of unilateral Weber type-B/SER-type ankle fractures shortly post-trauma using T2 relaxation time. Material and Methods Fifty one fractured ankles were gathered from consecutively screened patients, compiled initially for RCT studies, and treated at Oulu University Hospital and classified as stable (n = 28) and unstable fractures (n = 23) based on external-rotation stress test: medial clear space of ≥5 mm was interpreted as unstable. A control group of healthy young individuals (n = 19) was also gathered. All ankles were imaged on average 9 (range: 1 to 25) days after injury on a 3.0T MRI unit for T2 relaxation time assessment, and the cartilage was divided into sub-regions for comparison. Results Control group displayed significantly higher T2 values in tibial cartilage compared to stable (six out of nine regions, p-values = .003-.043) and unstable (six out of nine regions, p-values = .001-.037) ankle fractures. No differences were detected in talar cartilage. Also, no differences were observed between stable and unstable fractures in tibial or talar cartilage. Conclusions Lower T2 relaxation times of tibial cartilage in fractured ankles suggest intact extra cellular matrix (ECM) of the cartilage. Severity of the ankle fracture, measured by ankle stability, does not seem to increase ECM degradation immediately after trauma.
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Affiliation(s)
- Sami Lehtovirta
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Victor Casula
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | | | | | | | - Miika T. Nieminen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Eveliina Lammentausta
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Jaakko Niinimäki
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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Musahl V, Nazzal EM, Lucidi GA, Serrano R, Hughes JD, Margheritini F, Zaffagnini S, Fu FH, Karlsson J. Current trends in the anterior cruciate ligament part 1: biology and biomechanics. Knee Surg Sports Traumatol Arthrosc 2022; 30:20-33. [PMID: 34927221 DOI: 10.1007/s00167-021-06826-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022]
Abstract
A trend within the orthopedic community is rejection of the belief that "one size fits all." Freddie Fu, among others, strived to individualize the treatment of anterior cruciate ligament (ACL) injuries based on the patient's anatomy. Further, during the last two decades, greater emphasis has been placed on improving the outcomes of ACL reconstruction (ACL-R). Accordingly, anatomic tunnel placement is paramount in preventing graft impingement and restoring knee kinematics. Additionally, identification and management of concomitant knee injuries help to re-establish knee kinematics and prevent lower outcomes and registry studies continue to determine which graft yields the best outcomes. The utilization of registry studies has provided several large-scale epidemiologic studies that have bolstered outcomes data, such as avoiding allografts in pediatric populations and incorporating extra-articular stabilizing procedures in younger athletes to prevent re-rupture. In describing the anatomic and biomechanical understanding of the ACL and the resulting improvements in terms of surgical reconstruction, the purpose of this article is to illustrate how basic science advancements have directly led to improvements in clinical outcomes for ACL-injured patients.Level of evidenceV.
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Affiliation(s)
- Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA.
| | - Gian Andrea Lucidi
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA.,IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rafael Serrano
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | | | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Freddie H Fu
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA, USA
| | - Jon Karlsson
- The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Gong H, Qiao X, Chen L. [Research progress of lateral femoral notch sign in diagnosis of anterior cruciate ligament rupture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1200-1204. [PMID: 34523289 DOI: 10.7507/1002-1892.202104078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the relationship between lateral femoral notch sign (LFNS) and anterior cruciate ligament (ACL) rupture. Methods The relevant literature of LFNS at home and abroad in recent years was retrospectively reviewed, and its mechanism, diagnostic criteria and influencing factors in diagnosis of ACL rupture were summarized and analyzed. Results The LFNS is associated with rotational stability of the knee. As an indirect sign of ACL rupture, the LFNS has high clinical diagnostic value, especially the diagnosis of ACL rupture with lateral meniscus injury. Conclusion The diagnostic criteria and influencing factors of LFNS in diagnosis of ACL rupture are still unclear and controversial, which needs further study.
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Affiliation(s)
- Heng Gong
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China.,Department of Orthopedics, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China
| | - Xinrong Qiao
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China.,Department of Radiology, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China
| | - Lianxu Chen
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China.,Department of Orthopedics, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China
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Lucidi GA, Grassi A, Di Paolo S, Agostinone P, Neri MP, Macchiarola L, Dal Fabbro G, Zaffagnini S. The Lateral Femoral Notch Sign Is Correlated With Increased Rotatory Laxity After Anterior Cruciate Ligament Injury: Pivot Shift Quantification With A Surgical Navigation System. Am J Sports Med 2021; 49:649-655. [PMID: 33449808 DOI: 10.1177/0363546520982002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The lateral femoral notch sign (LNS) is a bony impression on the lateral femoral condyle correlated with anterior cruciate ligament (ACL) injury. Its presence is associated with lateral meniscal injury and higher cartilage degradation on the lateral femoral condyle. PURPOSE/HYPOTHESIS The purpose was to investigate the effect of the presence and magnitude of LNS on rotatory instability. The hypothesis was that a positive LNS is correlated with a high-grade pivot shift (PS). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 90 consecutive patients with complete ACL tears between 2013 and 2017 underwent intraoperative kinematic evaluation with the surgical navigation system and were included in the present study. The same surgeon performed a standardized PS under anesthesia. The PS was quantified through the acceleration of the lateral compartment during tibial reduction (PS ACC) and the internal-external rotation (PS IE). Presence and depth of LNS were evaluated on sagittal magnetic resonance images (1.5-T). RESULTS In 47 patients, the LNS was absent; in 33, the LNS depth was between 1 mm and 2 mm; and in 10 patients, it was deeper than 2 mm. Patients with a notch deeper than 2 mm showed increased PS ACC and PS IE compared with the group without the LNS. However, no significant differences were present between the group with a notch between 1 and 2 mm and the patients without LNS. Receiver operating characteristic curve analysis showed that 2 mm was the most predictive cutoff value to identify the "high-grade rotatory instability" group, with an accuracy of 77.8% and 74.4% and a specificity of 95.5% and 93.9% referred to the PS ACC and PS IE, respectively. CONCLUSION The presence of a lateral LNS deeper than 2 mm could be used for the preoperative identification of patients with a high risk of increased rotatory instability.
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Affiliation(s)
- Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Pia Neri
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Fate of the lateral femoral notch following early anterior cruciate ligament reconstruction. Knee 2020; 27:414-419. [PMID: 32037234 DOI: 10.1016/j.knee.2020.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/18/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The goal of this longitudinal study was to investigate the fate of the lateral femoral notch (LFN), which is frequently seen as an impaction fracture of the lateral femoral condyle in patients with anterior cruciate ligament (ACL) tears. METHODS Patients who underwent early ACL reconstruction between 2006 and 2010 were reviewed. If post-injury magnetic resonance images showed an LFN greater than 1.5 mm in depth, patients with untreated LFN were followed. Two blinded observers performed quantitative and qualitative imaging analysis. RESULTS Sixteen patients (five women, 11 men) were available for follow-up nine years (six to 10 years) post-injury. The median defect area of the LFN significantly decreased from 2.3 cm2 (range: 0.9-3.8 cm2) to 1.6 cm2 (range: 0.4-3.2 cm2) (P < .001). The defect depth did not significantly change from 2.3 mm (range: 2.0-3.6 mm) to 2.5 mm (range: 1.3-3.6 mm) (P > .05). The International Cartilage Repair Society (ICRS) score increased from 1.5 (range: 0-3) post-injury to 2.0 (range: 0-4) at follow-up (P < .01). The Lysholm score was 93 (72-100), the Tegner activity level was 6 (3-9) and the knee injury and osteoarthritis outcome score (KOOS) score was 97 (91-100). CONCLUSIONS The defect area of the LFN decreased overtime, whereas the depth of the impression remained. Focal cartilage lesions were found in all except two patients post-injury and progressed during follow-up. However, patient-reported outcome scores were satisfying.
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