Dimensions of the intercondylar notch and the distal femur throughout life

Transcription

1 Dimensions of the intercondylar notch and the distal femur throughout life Poster No.: P-0089 Congress: ESSR 2013 Type: Scientific Exhibit Authors: L. Hirtler, S. Röhrich, F. Kainberger; Vienna/AT Keywords: Anatomy, Musculoskeletal bone, Musculoskeletal joint, MR, Physiological studies, Epidemiology DOI: /essr2013/P-0089 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 14

2 Purpose Information concerning the size of the intercondylar notch (IN) is scarce in literature, especially with respect to populations less frequently treated in arthroscopy as it is the case in children and older people. Age-dependent variations of the bony shapes may be associated with age-related differences in manifestations of knee injuries. The morphology of the IN was already shown to be an important parameter for the development of injuries of the anterior cruciate ligament (ACL) [7-11] and of mucoid ACL degeneration [1-6]. As the ACL is not only impinged against the roof but also against the lateral wall of the IN, information of the development of this structure could be relevant in predicting the risk for ACL rupture and its degeneration. The purpose of this study was to show the development and changes of the IN during life. Attributing the associated features to a certain age bracket could help to understand potential causes of an increase in injury to the knee at different stages of life. For assessing potential differences between genders in bony morphology of the knee, the data of female subjects were compared to the data measured from male subjects. Methods and Materials Included were all patients recieving a 3-Tesla knee-scan at one specific scanner at our radiologic institute between 2008 and 2012 (n=1440). The following exclusion criteria were defined: adequate quality of the images, previous arthroscopy or open surgery, fracture or dysplasia of the distal femur or proximal tibia, osteoarthritic changes to the IN or tumor. Considering these criteria 333 subjects were selected. The subjects were subdivided into six groups depending on their respective age at the date of examination: < 11 a (n=37, male=21, female=16) a (n=56, male=26, female=30) a (n=61, male=31, female=30) a (n=61, male=31, female=30) Page 2 of 14

3 46-60 a (n=58, male=28, female=30) > 60 a (n=60, male=30, female=30) On coronal images the following parameters were measured: the width of the lateral and medial femoral condyle the notch width (NW) the total width of the distal femur These measurements (Fig. 1 on page 3) on the slice depciting the midsubstance of the anterior cruciate ligament (ACL) on the level of the popliteal groove [8]. The notch width index (NWI) - the ratio between the NW and the total width of the distal femur - was calculated [21]. The condyle index (CI) was defined as the ratio between medial and lateral condyle width. All measurements were executed by two independent investigators. Images for this section: Page 3 of 14

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5 Fig. 1: Schematic view of a left knee. Measurements were taken in a coronal slice depicting the intermediate part of the ACL. A line parallel to the femoral condyles was drawn at the level of the popliteal groove. The widths of the medial femoral condyle (MC), of the femoral notch (NW) and the lateral femoral condyle (LC) were measured. Page 5 of 14

6 Results An increase of all the values towards the group of > 60 years was observed. The width of the distal femur, of the lateral and medial condyle and of the IN changes significantly (p<0,01) during life. The CI shows a significant difference (p<0,05) between the group of > 60 and as well as between the group of > 60 and of all the subjects had a NWI<0,2, of which most were aged between 11 and 30 years. There was no significant difference in NWI, gender and between left or right knee. The following figures show exemplar images for all age-groups and sides: Fig. 2 on page 6, Fig. 3 on page 7, Fig. 4 on page 8, Fig. 5 on page 9 Images for this section: Page 6 of 14

7 Fig. 2: Morphological changes of the intercondylar region during life: left knees of male supjects, a: group <11, b: group 11-20, c: group 21-30, d: group 31-45, e: group 46-60, f: group >60 Page 7 of 14

8 Fig. 3: Morphologigal changes of the intercondylar region during life: right knees of male supjects, a: group <11, b: group 11-20, c: group 21-30, d: group 31-45, e: group 46-60, f: group >60 Page 8 of 14

9 Fig. 4: Morphologigal changes of the intercondylar region during life: left knees of female supjects, a: group <11, b: group 11-20, c: group 21-30, d: group 31-45, e: group 46-60, f: group >60 Page 9 of 14

10 Fig. 5: Morphologigal changes of the intercondylar region during life: right knees of female supjects, a: group <11, b: group 11-20, c: group 21-30, d: group 31-45, e: group 46-60, f: group >60 Page 10 of 14

11 Conclusion Growth of the femoral component of the knee is concluded below the age of 11. Thereafter only minimal changes could be observed. The significant changes in width are due to growth and physiological remodeling of the bone due to strain. The gender difference at length discussed in literature [16-20] concerning the size of the distal femur and of the intercondylar notch could not be shown. Charlton et al. [15] has put this in perspective, describing that these significant differences in the sizes of the femoral notch and the ACL size described in literature are related to the normal differences in height and weight. To exclude the variability of the measurements depending on height, weight and age of the subjects, the NWI and CI were used for objective comparison. The increase of low NWI between 11 and 30 years could be a reason for the prevalence of ACL-rupture and mucoid ACL-degeneration in this age group. This is in agreement with the results of Domzalski et al. [8] depicting the rupture risk of 11 to 17 years old adolescents. This study extends these risk area up to 30 years old adults. The increase of NW and NWI in association of the development of intercondylar ridges described by Chudasama et al. [3] in the group of >60 could be associated with the development of ACL degeneration [4, 12-14]. Images for this section: Page 11 of 14

12 Fig. 6: Ridges (arrowheads) at the distal outlet of the intercondylar region, constraining the cruciate ligaments. Page 12 of 14

13 References Cha, J.H., et al., Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation. Skeletal Radiol, (9): p Cha, J.R., et al., Symptomatic mucoid degeneration of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc, (3): p Chudasama, C.H., V.C. Chudasama, and M.M. Prabhakar, Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Indian J Orthop, (5): p Kim, T.H., et al., Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Arthroscopy, (6): p Leon, H.O., et al., Intercondylar notch stenosis in degenerative arthritis of the knee. Arthroscopy, (3): p Narvekar, A. and S. Gajjar, Mucoid degeneration of the anterior cruciate ligament. Arthroscopy, (2): p Al-Saeed, O., et al., Association of femoral intercondylar notch morphology, width index and the risk of anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc, (3): p Domzalski, M., P. Grzelak, and P. Gabos, Risk factors for Anterior Cruciate Ligament injury in skeletally immature patients: analysis of intercondylar notch width using Magnetic Resonance Imaging. Int Orthop, (5): p Hoteya, K., et al., Association between intercondylar notch narrowing and bilateral anterior cruciate ligament injuries in athletes. Arch Orthop Trauma Surg, (3): p Shelbourne, K.D., T.J. Davis, and T.E. Klootwyk, The relationship between intercondylar notch width of the femur and the incidence of anterior cruciate ligament tears. A prospective study. Am J Sports Med, (3): p Uhorchak, J.M., et al., Risk factors associated with noncontact injury of the anterior cruciate ligament: a prospective four-year evaluation of 859 West Point cadets. Am J Sports Med, (6): p Everhart, J.S., et al., Association of noncontact anterior cruciate ligament injury with presence and thickness of a bony ridge on the anteromedial aspect of the femoral intercondylar notch. Am J Sports Med, (8): p Hernigou, P. and J.M. Garabedian, Intercondylar notch width and the risk for anterior cruciate ligament rupture in the osteoarthritic knee: evaluation by plain radiography and CT scan. Knee, (4): p Park, H.S., et al., A knee-specific finite element analysis of the human anterior cruciate ligament impingement against the femoral intercondylar notch. J Biomech, (10): p Page 13 of 14

14 15. Charlton, W.P., et al., Differences in femoral notch anatomy between men and women: a magnetic resonance imaging study. Am J Sports Med, (3): p Anderson, A.F., et al., Correlation of anthropometric measurements, strength, anterior cruciate ligament size, and intercondylar notch characteristics to sex differences in anterior cruciate ligament tear rates. Am J Sports Med, (1): p Davis, T.J., K.D. Shelbourne, and T.E. Klootwyk, Correlation of the intercondylar notch width of the femur to the width of the anterior and posterior cruciate ligaments. Knee Surg Sports Traumatol Arthrosc, (4): p Everhart, J.S., D.C. Flanigan, and A.M. Chaudhari, Anteromedial ridging of the femoral intercondylar notch: an anatomic study of 170 archival skeletal specimens. Knee Surg Sports Traumatol Arthrosc, Shelbourne, K.D., W.A. Facibene, and J.J. Hunt, Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc, (4): p Stijak, L., et al., Correlation between the morphometric parameters of the anterior cruciate ligament and the intercondylar width: gender and age differences. Knee Surg Sports Traumatol Arthrosc, (7): p Lund-Hanssen, H., et al., Intercondylar notch width and the risk for anterior cruciate ligament rupture. A case-control study in 46 female handball players. Acta Orthop Scand, (5): p Personal Information L. Hirtler, S. Röhrich: Medical University of Vienna, Center for Anatomy and Cell Biology, Department for Systematic Anatomy, Study Group Clinical Anatomy Mail to: lena.hirtler@meduniwien.ac.at F. Kainberger: Medical University of Vienna, Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology Page 14 of 14