Smaller intercondylar notch size and smaller ACL volume increase posterior cruciate ligament rupture risk

Abstract

Purpose Little is known about risk factors for sustaining a posterior cruciate ligament (PCL) rupture. Identifying risk factors is the first step in preventing a PCL rupture from occurring. The morphology of the knee in patients who ruptured their PCL may differ from that of control patients. The hypothesis was that the intercondylar notch dimensions, 3-D volumes of the intercondylar notch and, the 3-D volumes of both the ACL and the PCL were correlated to the presence of a PCL rupture. Methods The magnetic resonance imaging (MRI) scans of 30 patients with a proven PCL rupture were compared to 30 matched control patients with proven intact ACL and PCL. Control patients were selected from patients with knee trauma during sports but without cruciate ligament injury. Patients have been matched for age, height, weight, BMI, and sex. The volumes of the intercondylar notch and both the ACL and PCL were measured on 3D reconstructions. Second, the bicondylar width, the notch width, and the notch width index were measured of all subjects. The relationship between our measurements and the presence of a PCL rupture was analysed. Results The results show a significant difference in the volumes of the intercondylar notch and the ACL between patients with a ruptured PCL and control patients. Patients with a PCL rupture have smaller intercondylar notch volumes and smaller ACL volumes. There were no significant differences in the bicondylar width, notch width, and notch width index. In the control patients, a significant correlation between the volume of the PCL and the volume of the ACL was found (0.673, p < 0.001). Conclusion Patients with a PCL rupture have smaller intercondylar volumes and smaller ACL volumes when compared to control patients. Second, patients with smaller ACL volumes have smaller PCL volumes. This study shows, for the first time, that there are significant size and volume differences in the shape of the knee between patients with a PCL rupture and control patients. Level of evidence IV.

Posterior tibial slope, notch width index and tibial tubercle to trochlear groove distance contribute to development of mucoid degeneration of the anterior cruciate ligament: a systematic review

“…A recent study found that there was no significant difference in notch width index values between those with ACL rupture and healthy ACL [8]. Another study found similar results, where notch width index was not significantly different between ligament rupture and control patients [15]. However, these findings are controversial as other studies state that females and paediatric patients are at high risk for ACL rupture due to having a smaller notch width index [18, 32].…”

Poor tibiofemoral congruity increases the risk of posterior cruciate ligament injury.

“…Van Kuijk et al [6] used statistical shape modeling software and found that smaller intercondylar notch and sharper angles were associated with PCL injury. van Kuijk et al [5] analyzed 30 cases of PCL injury and 30 control groups and showed that there were no signi cant differences in intercondylar notch width, femoral bicondyle width, and coronal NWI. Liu et al [4] showed that patients with PCL rupture did not have narrow intercondylar notch, and there was no signi cant difference in the angle of intercondylar notch in the PCL rupture group and the control group in both female and male populations.…”

“…But Liu et al [4] showed that patients with PCL rupture were not found to have narrow intercondylar notch. The notch width index is a parameter generally used to assess the width of the femoral condylar notch, and some studies have suggested that a lower index of intercondylar notch width is associated with posterior cruciate ligament rupture [4] , but it has also been suggested that posterior cruciate ligament injury has no correlation with the notch width index [5] . Anatomical abnormalities in the proximal tibia also affect PCL, and the smaller PTS, the greater pressure on the PCL, which appears to be a risk factor for primary PCL injury [7] .…”

“…Studies have shown that posterior cruciate ligament rupture is related to the anatomical morphology of the distal femur and proximal tibia, such as the anatomical parameters of the intercondylar notch, the morphology of the intercondylar notch, and the anatomical parameters of the tibial spine [4][5][6][7][8]22] , However, there are relatively few studies on risk factors for PCL injury and there is no uniform consensus. Smaller intercondylar notch width, sharper angles, and reduced femoral bicondyle width have been reported to be risk factors for PCL injury [5,6] . But Liu et al [4] showed that patients with PCL rupture were not found to have narrow intercondylar notch.…”

Decreased medial posterior tibial slope is associated with an increased risk of posterior cruciate ligament rupture

“…Rupture of the PCL is one of the most severe knee injuries, typically caused by a posteriorly directed force [11,38]. PCL rupture can lead to persistent instability, decreased activity capacity and subsequent development of degenerative joint diseases [5,14,25,33,39]. Although PCL injury has a lower incidence than anterior cruciate ligament (ACL) injury, the PCL injury incidence would be expected to increase with an increase in the number of sports injuries and traic accidents [8,29].…”