No abstract

Background: ACL injuries are infamously known for disability in young adults and require surgical reconstruction. The need of time is to predict predisposing factors and prevent ACL injuries.The incidence of ACL injuries has been associated with various factors related to the morphology of distal femur and proximal tibia.Hence, purpose of this study was to assess the relationship of morphology of distal femur by assessing Notch Width(NW), Notch Width Index (NWI), and Notch shape calculated preoperatively on MRI in association with an ACL tear. Methods: The following randomized control study had 60 patients enrolled with non contact injury to knee who were equally divided into 2 groups i.e. ACL injury group and control group. ACL group had patients who had MRI proven ACL tear along with clinical findings suggestive of ACL tear whereas control contained patients with intact ACL. Demographic data was collected and NW, NWI and Notch shape were determined on coronal sections of MRI sequences. Results: Positive correlation of ACL tear was seen with NW, BCW, NWI, NWP, and NWJ. Smaller Notch Width showed higher incidence of ACL tear (p ¼ 0.019). The mean NWI in the injured and control knee is 0.31 ± 0.01 and 0.27 ± 0.01 respectively and was statistically significant(p < 0.001). A shaped Notch (60%) was commonly seen in ACL tear group and U shaped notch (73.3%) was commonly seen in control group.We found the cut off value for the prediction of ACL tear of NWI was 0.29 with a sensitivity of 90% and specificity of 86.7%. Conclusion: ACL injuries in the given population have shown higher incidence with narrow femoral intercondylar notch, smaller notch width index, 'A' shaped femoral notch. If any of the above findings are present in the MRI, its important to counsel the subjects about the increased risk of ACL injuries in them and take preventive measures.

The primary outcome measure of this study was to determine the effect of hamstring graft size on the functional outcome of arthroscopic anterior cruciate ligament reconstruction (ACL-R) and the secondary outcome was to ascertain the effect on revision surgery at the two-year follow-up. MethodsThis is a prospective comparative study of 144 consecutive patients undergoing primary ACL reconstruction using a hamstring autograft. All patients underwent graft harvesting and ACL reconstruction with the standard technique. The graft diameter was recorded intraoperatively using a graft sizer. All patients were followed up with the Knee Injury and Osteoarthritis Outcome Score (KOOS) recorded at preop, six weeks, six months, one year, and two years and whether they underwent revision during this period was documented. ResultsThe mean KOOS for patients with a ≤ 7mm graft diameter was 80.5±13.1, which was significantly lower compared to those with graft > 7 mm of 88.3±8.5, respectively (p<0.001) at the two years follow-up. Patients with graft ≤ 7mm did poorly, especially with mean KOOS subscores of sports and recreation and quality of life (p<0.05). Twenty-three point one percent (23.1%; 3 out 13) of patients with a graft < 7mm underwent revision, whereas only 5.8% and 2.6% of patients underwent revision with a graft diameter of 7.1-8.0 and 8.1-9.0 (p=0.027). ConclusionsThe smaller Hamstring graft diameter leads to poorer functional outcomes of the patient's ACL reconstruction. Though the number of revisions was high among those with a graft diameter of ≤ 7mm, multicentric studies with many revisions are required to confirm the relation.