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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 1  |  Page : 38-40

Anatomical considerations of intercondylar notch dimensions of femur in cadavers with intact anterior cruciate ligament


Department of Orthopedics, Aiims Raipur, Chhattisgarh, India

Date of Submission18-Apr-2021
Date of Acceptance02-May-2021
Date of Web Publication16-Jun-2021

Correspondence Address:
Dr. J Rakshit
Department of Orthopedics, Aiims Raipur, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jotr.jotr_27_21

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  Abstract 


Background: The femoral intercondylar notch is an anatomic site of interest since it houses the anterior cruciate ligament which is one of the importantstructure stabilizing knee. The configuration of the intercondylar notch is related to the active functioning of the cruciate ligaments. Objective: The primary objective of the study was to measure the intercondylar notch dimensions of femur in cadavers with intact ACL and its correlation. Materials and Methods: The study was done on 30 cadaveric knees provided by department of Anatomy. The measurements of intercondylar notch like width at the base of the notch, width in the middle of the notch, width at the top of the notch, height of the notch were measured using a digital vernier callipers with knee in 90 degree flexion. Results: Among the 30 cadaveric knees whose intercondylar notch dimensions were measured, 20 were male and 10 were female. All the 30 knees were categorized into A-, U, and W-shaped notch knees. A shaped intercondylar notch was accounted for 13, U shaped 16 and W shaped 1 knee. There was a significant difference (P = 0.048) in notch width at base in A-, U-, and W-shaped notches. The highest is of W followed by A- and U-shaped notches. Conclusion: This study shreds light on the normal intercondylar notch dimensions of femur and its correlation with different notch shapes. This study would help for the comparison of notch dimensions and finding out the causal reason for ACL insufficiency.


How to cite this article:
Agrawal AC, Rakshit J, Sakale H, Kar B, Raj M. Anatomical considerations of intercondylar notch dimensions of femur in cadavers with intact anterior cruciate ligament. J Orthop Traumatol Rehabil 2021;13:38-40

How to cite this URL:
Agrawal AC, Rakshit J, Sakale H, Kar B, Raj M. Anatomical considerations of intercondylar notch dimensions of femur in cadavers with intact anterior cruciate ligament. J Orthop Traumatol Rehabil [serial online] 2021 [cited 2021 Dec 9];13:38-40. Available from: https://www.jotr.in/text.asp?2021/13/1/38/318404




  Introduction Top


Intercondylar notch of the femur assumes an important role in the pathomechanics of knee injuries. The lower end of the femur is composed of two eccentrically placed rounded condyles with lateral being larger than medial. Anteriorly, between these condyles lie the patella femoral groove and posteriorly, the condyles are separated by the intercondylar notch.[1]

The intercondylar notch of femur is important in the fact that it houses the most crucial ligaments of knee responsible for maintaining the stability of the knee namely the anterior and posterior cruciate ligaments.[2] The space available for the cruciate ligament is determined by the dimensions of the notch including the depth, width, and shape.

The configuration of the intercondylar notch is related to the active functioning of the cruciate ligaments. Many investigators have studied the geometry of intercondylar notch and related it with anterior cruciate ligament (ACL) injuries. They found that narrow intercondylar notches of femur are a risk factor for ACL insufficiency.[3]

Due to increasing arthritic changes seen in the younger population leading to osteophytes formation in the knee, the incidence of ACL tear is more. Literature regarding the anatomical aspects of intercondylar notch of femur is less and we took up this study to evaluate the intercondylar notch dimensions of femur.


  Materials and Methodology Top


In this study, 30 embalmed cadaveric knees provided by the department of anatomy with intact ACL were utilized. The knees on open dissection were free of arthritic changes and had intact ACL. The measurements were taken in the cadavers at the anterior outlet of the knees with the knee in 90° of flexion [Figure 1].
Figure 1: (a-c) Intercondylar notch dimensions at base, middle third and apex respectively

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The following measurements were noted using a digital Vernier calipers.

  • Width at the base of the notch
  • Width in the middle of the notch
  • Width at the top of the notch
  • Height of the notch.


Three categories of notch shape were identified based on a prior study conducted by Anderson et al. and Ireland et al.

  • A-shaped
  • U-shaped
  • W-shaped.


A-shaped notch was defined as a notch shape that narrowed from base to midsection to apex by visual inspection.

U-shaped notch was one in which the midsection did not taper from the base.

W-shaped notch was one that exhibited characteristics of a U-shaped notch but also had two apparent apices rather than a classic flat roof.

All the analyses were carried out by means of Windows SPSS software (IBM Corp., Released 2013. IBM SPSS Statistics for Windows, version 22.0. (IBM Corp., Armonk, NY, USA). Appropriateness of variables was investigated with the visual and analytical methods. Descriptive statistical data were presented as mean, standard deviation, numbers, and percentage.


  Results Top


In this study, 15 cadavers accounting for 30 knees were evaluated thoroughly among which 10 were male cadavers and 5 were female cadavers.

All the 30 knees were categorized into A-, U, and W-shaped notch knees. A shaped intercondylar notch was accounted for 13, U shaped 16 and W shaped 1 knee.

The mean notch height with A-shaped notches was 23.30 mm, U-shaped was 22.56 mm, and W-shaped was 22 mm. There was no significant difference (P = 0.755) in notch height in A-, U- and W-shaped notches [Table 1].
Table 1: Comparison of notch height in different shape of notch

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The mean notch width at base with A-shaped notches was 23.30 mm, U-shaped was 22.56 mm, and W-shaped was 22 mm [Table 2].
Table 2: Comparison of width at base of notch in different shape of notch

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There was a significant difference (P = 0.048) in notch width at base in A-, U-, and W-shaped notches. The highest is of W followed by A- and U-shaped notches.

The mean notch width at middle 1/3rd with A-shaped notches was 18.76 mm, U-shaped was 18 mm, and W-shaped was 20 mm. There was no significant difference (P = 0.695) in notch height in A-, U-, and W-shaped notches [Table 3].
Table 3: Comparison of width in the middle of notch in different shapes of notch

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The mean notch width at apex with A-shaped notches was 14 mm, U-shaped was 14.5 mm, and W-shaped was 15 mm. There was no significant difference (P = 0.891) in notch height in A-, U-, and W-shaped notches [Table 4].
Table 4: Comparison of width at the apex of notch in different shape of notch

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  Discussion Top


One of the most common presenting problems in sports clinic in the country is with knee instability following a twisting injury among athletes and young population. The majority of the cases with this problem come with ACL insufficiency.

The ACL is a ligament of necessity since injury of the same not only hampers the functional need of the affected person but also financially too due to its protracted course.[4] ACL is one of the two cruciate ligaments of the knee which originates from the anteromedial aspect of the tibia plateau and runs superiorly, laterally, and posteriorly and gets inserted on the lateral femoral condyle.

Roughly around 40° of inclination exists between the roof of the intercondylar notch and the longitudinal axis of femur so that the roof is near the anterior surface of the ACL during knee in full extension.[5]

In our study, we found that majority had U-shaped notches followed by A-shaped notches. A shaped notch is troublesome during arthroscopic ACL reconstruction due to poor visibility through the anteromedial portal. Ireland et al., where they classified notches based on measurements taken on radiographs concluded that A-shaped notches were smaller in width at base compared to the non-A-shaped notches.[6]

Anderson et al., 1987 in their study described the changes in the shape of the intercondylar notch. The shape was “inverted U,” triangular or wave shaped. The incidence of ACL rupture increases with narrow, triangular notch with straight edges.[7]

U-shaped notch was wider at the base as compared to A-shaped notch with a mean of 19.75 mm and was statistically significant compared toother notch shapes (P = 0.048). All the other parameters are statistically insignificant.

Many studies have used notch width index (NWI) and notch depth index (NDI) to assess the intercondylar notch dimensions. NWI represents the ratio of the notch width to the condylar width of the femur and NDI as a ratio of the notch depth to condylar depth. However, our study used the raw dimensions of the whole intercondylar notch to evaluate and compare it among different notch shapes.


  Conclusion Top


This study shreds light on the normal intercondylar notch dimensions of femur and its correlation with different notch shapes. This study would help for the comparison of notch dimensions and finding out the causal reason for ACL insufficiency.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ellis H. Gray's Anatomy. 37th ed. P. L. Williams, R. Warwick, M. Dyson, L. H. Bannister. 305 × 235 mm. Pp. 1598. Illustrated. 1989. EDINBURGH: Churchill LIVINGSTONE. £70.00. Br J Surg 1989;76:1359.  Back to cited text no. 1
    
2.
Davis TJ, Shelbourne KD, Klootwyk TE. Correlation of the intercondylar notch width of the femur to the width of the anterior and posterior cruciate ligaments. Knee Surg Sports Traumatol Arthrosc 1999;7:209-14.  Back to cited text no. 2
    
3.
Souryal TO, Freeman TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med 1993;21:535-9.  Back to cited text no. 3
    
4.
Jomha NM, Pinczewski LA, Clingeleffer A, Otto A. Arthroscopic reconstruction of anterior cruciate ligament with patellar-tendon autograft and interferrence screw fixation. The results at seven years. J Bone Joint Surg (Br) 1999;81:775-9.  Back to cited text no. 4
    
5.
Miller RH, Azar FM. Knee injuries. In: Campbell's Operative Orthopaedics. Elsevier Radarweg 29, 1043 NX Amsterdam, The Netherlands; 2008. p. 2395-600.  Back to cited text no. 5
    
6.
Ireland ML, Ballantyne BT, Little K, McClay IS. A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2001;9:200-5.  Back to cited text no. 6
    
7.
Anderson AF, Lipscomb AB, Liudahl KJ, Addlestone RB. Analysis of the intercondylar notch by computed tomography. Am J Sports Med 1987;15:547-52.  Back to cited text no. 7
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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