Intercondylar Notch Width as a Risk Factor for Medial Femoral Condyle Osteochondritis Dissecans in Skeletally Immature Patients

Chow, Roxanne M.; Guzman, Maurice S.; Dao, Quang

doi:10.1097/bpo.0000000000000511

Cited by 23 publications

(21 citation statements)

References 14 publications

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“… 8 In a study by Chow et al, a narrower intercondylar notch width was implicated as a risk factor for juvenile OCD lesions. 12 They postulated that this anatomic risk factor might increase the likelihood for tibial eminence impingement and contribute to an OCD lesion. In a radiographic study of 103 knees using full-length standing radiographs, Jacobi et al found an association between medial condyle OCD and varus malalignment of the knee.…”

Section: Discussionmentioning

confidence: 99%

Ipsilateral Osteochondritis Dissecans-like Distal Femoral Lesions in Children with Blount Disease: Prevalence and Associated Findings

Edobor-Osula¹,

Wenokor²,

Bloom³

et al. 2020

Strategies in Trauma and Limb Reconstruction

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Purpose Our goal was to assess the prevalence of ipsilateral distal femoral osteochondritis dissecans (OCD)-like lesions in children with Blount disease, including factors associated with this finding. Materials and methods Characteristics of patients with an OCD-like lesion on an imaging study [(X-ray and/or magnetic resonance imaging (MRI)] were compared with those without such a finding. Results Over a 12-year period, 6/63 (10%) skeletally immature patients (9/87 limbs) with Blount disease had an OCD-like lesion visible on plain radiographs. Based on available MRI, 7/37 (19%) patients or 10/53 (19%) limbs had an OCD-like distal femoral lesion. All lesions were noted in the posterior third of the weight-bearing portion of the medial femoral condyle with intact overlying articular cartilage. All patients with OCD-like lesions were followed for an average of 1.9 years (range: 1–2.6 years), and complete radiographic resolution of lesion was noted in 7/9 limbs (78%). There was no association of the presence of OCD-like lesion with early- vs late-onset disease, gender, age at imaging, laterality, magnitude of deformity [mean mechanical axis deviation (MAD) 63.3 vs 71.9 mm], mean mechanical lateral distal femoral angle (mLDFA; 91.3 vs 89.7°), and mean medial proximal tibial angle (MPTA; 71.7 vs 71.8°). Children with an OCD-like lesion tended to have a lower mean body mass index (BMI; 21 vs 36, p = 0.003). Conclusion The overall prevalence of OCD-like lesions in the medial femoral condyle in children with Blount disease lesions is 10% using plain radiographs and at least 19% on MRI. Based on the numbers available, we were unable to demonstrate any associations between the presence of such lesions and the patient’s age, gender, or magnitude of varus deformity. Further research is needed to fully ascertain the aetiology and natural history of these benign appearing osteochondral imaging findings in children with Blount disease. Our current data support that these lesions do resolve with time and that no surgical intervention targeted at the femoral OCD-like lesion is warranted. Level of evidence Diagnostic study Level III. How to cite this article Edobor-Osula F, Wenokor C, Bloom T, et al. Ipsilateral Osteochondritis Dissecans-like Distal Femoral Lesions in Children with Blount Disease: Prevalence and Associated Findings. Strategies Trauma Limb Reconstr 2019;14(3):121–125.

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Section: Discussionmentioning

confidence: 99%

Ipsilateral Osteochondritis Dissecans-like Distal Femoral Lesions in Children with Blount Disease: Prevalence and Associated Findings

Edobor-Osula¹,

Wenokor²,

Bloom³

et al. 2020

Strategies in Trauma and Limb Reconstruction

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“…Many methods of notch size measurements on imaging have been described. 2,[8][9][10] However, most methods have been used to study the relationship of notch size to ACL injury, and few have tried to reproduce arthroscopic measurements. Zeng et al 11 performed a meta-analysis of 16 studies assessing the correlation between intercondylar notch size and the risk of ACL injury.…”

Section: Discussionmentioning

confidence: 99%

Intercondylar Notch Measurement During Arthroscopy and on Preoperative Magnetic Resonance Imaging

Vaswani

Meredith

Lian

et al. 2019

Arthroscopy Techniques

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Small intercondylar notch size is associated with increased risk of anterior cruciate ligament (ACL) injuries and increased difficulty of ACL reconstruction. When encountering a small notch during surgery, some surgeons may resort to a notchplasty, which has been shown to have associated morbidity. The ability to predict notch size on preoperative imaging could allow the orthopaedic surgeon to anticipate surgical difficulty such as an oversized graft and graft impingement and possibly avoid a notchplasty. Many methods have been proposed for measuring intercondylar notch size, but they do not correlate with intraoperative measurements or they utilize computed tomography scanning, which is not readily obtained before ACL reconstruction. The purpose of this study was to develop a method of notch measurement on preoperative radiography and magnetic resonance imaging that match intraoperative arthroscopic measurements. The method presented here can be used to identify narrow intercondylar notches, prepare for potential intraoperative challenges, and formulate surgical plans such as for graft choice in individualized ACL reconstruction.

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“…From the standpoint of the mechanical axis of the leg, there was no significant evidence of the specific mechanical axis change accounting for MFC OCD, as shown in LFC OCD. 16 As an anatomic risk factor for MFC OCD, Chow et al 6 recently demonstrated that knees with MFC OCD lesions have significantly narrower intercondylar notch width compared with controls using MRI scans. This study proposed a new approach to investigate anatomic risk factors predisposing to MFC OCD lesions.…”

Section: Discussionmentioning

confidence: 99%

“…This study proposed a new approach to investigate anatomic risk factors predisposing to MFC OCD lesions. 6 Thus, few concepts and findings have been introduced to unveil the etiological factor of MFC OCD; however, many things still remain unclear and have to be proven to elucidate the cause of MFC OCD.…”

Section: Discussionmentioning

confidence: 99%

Unique Anatomic Feature of the Posterior Cruciate Ligament in Knees Associated With Osteochondritis Dissecans

Ishikawa

Adachi

Yoshikawa

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Osteochondritis dissecans (OCD) of the knee is a disorder in juveniles and young adults; however, its etiology still remains unclear. For OCD at the medial femoral condyle (MFC), it is sometimes observed that the lesion has a connection with fibers of the posterior cruciate ligament (PCL). Although this could be important information related to the etiology of MFC OCD, there is no report examining an association between the MFC OCD and the PCL anatomy.Purpose:To investigate the anatomic features of knees associated with MFC OCD, focusing especially on the femoral attachment of the PCL, and to compare them with knees associated with lateral femoral condyle (LFC) OCD and non-OCD lesions.Study Design:Case-control study; Level of evidence, 3.Methods:We retrospectively reviewed 39 patients (46 knees) with OCD lesions who had undergone surgical treatment. Using magnetic resonance imaging (MRI) scans, the PCL attachment at the lateral wall of the MFC was measured on the coronal sections, and the knee flexion angle was also measured on the sagittal sections. As with non-OCD knees, we reviewed and analyzed 25 knees with anterior cruciate ligament (ACL) injuries and 16 knees with meniscal injuries.Results:MRIs revealed that the femoral PCL footprint was located in a significantly more distal position in the patients with MFC OCD compared with patients with LFC OCD and ACL and meniscal injuries. There was no significant difference in knee flexion angle among the 4 groups.Conclusion:The PCL in patients with MFC OCD attached more distally at the lateral aspect of the MFC compared with knees with LFC OCD and ACL and meniscal injuries.

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Intercondylar Notch Width as a Risk Factor for Medial Femoral Condyle Osteochondritis Dissecans in Skeletally Immature Patients

Abstract: Level III-case-control study.

Cited by 23 publications

References 14 publications

Ipsilateral Osteochondritis Dissecans-like Distal Femoral Lesions in Children with Blount Disease: Prevalence and Associated Findings

Ipsilateral Osteochondritis Dissecans-like Distal Femoral Lesions in Children with Blount Disease: Prevalence and Associated Findings

Intercondylar Notch Measurement During Arthroscopy and on Preoperative Magnetic Resonance Imaging

Unique Anatomic Feature of the Posterior Cruciate Ligament in Knees Associated With Osteochondritis Dissecans

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