The development of the intercondylar notch in the pediatric population

Lima, Fernando Martins de; Debieux, Pedro; Aihara, André Yui; Cardoso, Fabiano Nassar; Franciozi, Carlos Eduardo da Silveira; Grimberg, Alexandre; Fernandes, Ana

doi:10.1016/j.knee.2020.04.020

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…The femoral intercondylar notch stops growing at around 10 to 11 years of age, and it decreases slightly in size and reaches its final size around 13 to 14 years of age. 19 Measurement parameters such as notch width, notch angle, femoral condyle width, and notch width index are used to define 2-dimensional (2-D) intercondylar notch morphology. 27 In a study based on the MRI scan findings of 61 patients, Domzalski et al 11 showed that the risk of ACL rupture was higher among adolescent patients with smaller intercondylar notch widths.…”

Section: Discussionmentioning

confidence: 99%

Investigation of Morphometric Factors Associated With Adolescent ACL Rupture

Akcaalan,

Kavaklilar,

Caglar

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: There are no definitive anatomic morphometric risk factors for adolescent anterior cruciate ligament (ACL) injury. Purpose: To compare the parameters used to define the tibial and femoral morphometric structure of the knee between adolescent patients with and without ACL rupture. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were magnetic resonance imaging (MRI) scans and radiographs of 115 patients aged 10 to 17 years who were evaluated for ACL rupture at a single institution between February 1, 2019, and January 31, 2022. Images from 115 patients with intact MRI scans were included as controls. We investigated the following imaging parameters: tibial slope (on lateral radiograph), lateral condylar height, tibial sulcus height, medial condylar height, condylar width, intercondylar notch with, intercondylar notch angle, notch index, eminence width, tibial plateau width, eminence width/tibial plateau width, medial/lateral/overall eminence height, medial plateau depth, and 2 different eminence angles. Parameters were compared between groups using the chi-square, Fisher exact, Student t, or Mann-Whitney U test, as appropriate. Receiver operating characteristic analysis was conducted for cutoff values of significant parameters. Results: There were no significant differences in age, sex, or side affected between groups. Only the medial plateau depth was found to be statistically significant between the ACL rupture and ACL intact groups (2.6 vs 2.2 mm; P = .015). A statistically significant cutoff value could not be obtained for the medial plateau depth. Conclusion: Medial plateau depth was found to be significantly greater in adolescent patients with ACL rupture compared with ACL-intact controls.

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Section: Discussionmentioning

confidence: 99%

Investigation of Morphometric Factors Associated With Adolescent ACL Rupture

Akcaalan,

Kavaklilar,

Caglar

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…One could assume that an uneven distribution of growth arrest could influence this parameter. Several other studies have assessed the relationship between the femoral notch–intercondylar distance and stability of the anterior cruciate ligament [ 26 , 27 , 30 - 32 ]. Iriuchishima et al observed a higher incidence of anterior cruciate ligament injury in patients with a relatively short femoral notch–intercondylar distance [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Radiographic reference values of the central knee anatomy in 8–16-year-old children

Vogt

Hvidberg

Rölfing

et al. 2023

ActaO

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Background and purpose: For correction of leg-length discrepancy or angular deformity of the lower limb in skeletally immature patients temporary or permanent (hemi-)epiphysiodesis can be employed. These are reliable treatments with few complications. Recently, radiographic analysis of treatment-related alterations of the central knee anatomy gained interest among pediatric orthopedic surgeons. To date the comparison and adequate interpretation of potential changes of the central knee anatomy is limited due to the lack of defined standardized radiographic references. We aimed to establish new reference values of the central knee anatomy.Patients and methods: A retrospective analysis of calibrated longstanding anteroposterior radiographs of 254 skeletally immature patients with a chronological age ranging from 8 to 16 years was conducted. The following radiographic parameters were assessed: (1) femoral floor angle, (2) tibial roof angle, (3) width at femoral physis, and (4) femoral notch–intercondylar distance.Results: All observed radiographic parameters were normally distributed with a mean age of 12.4 years (standard deviation [SD] 2, 95% confidence interval [CI] 12.2–12.6). Mean femoral floor angle was 142° (SD 6, CI 141.8–142.9), mean tibial roof angle was 144° (SD 5, CI 143.7–144.1), mean width at femoral physis was 73 mm (SD 6, CI 72.8–73.9), and mean femoral notch–intercondylar distance was 8 mm (SD 1, CI 7.5–7.7). The estimated intraclass correlation coefficient values were excellent for all measurements.Conclusion: This study provides new radiographic reference values of the central knee anatomy for children between 8 and 16 years and we suggest considering values within the range of 2 SD as the physiological range.

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“…Putur et al documented similar, consistent growth in ACL measurements with subsequent plateau at age 11.8 years 3. Lima et al also noted progressively increasing bicondylar distance during pre-adolescence that plateaued at age 13 years in females and age 15 years in males 16. Kim et al reported disproportionate lengthening of the PCL with minimal change in width during skeletal maturation 8.…”

mentioning

confidence: 84%

“…14,15 Notch width increases until ages 13 to 14 years after which the notch narrows through adolescence and adulthood, which may be a contributing factor predisposing to injury. [15][16][17] Investigation of PCL morphology may elucidate risk factors for PCL injury, pathophysiology of injury pattern, and optimal graft placement during surgical repair. The authors are not aware of prior work that has comprehensively documented developmental changes in PCL morphology assessed on MRI in children and adolescents.…”

Section: Key Conceptsmentioning

confidence: 99%

Age-Related Posterior Cruciate Ligament Surgical Anatomy in a Skeletally Immature Population: An MRI Study

Flaugh¹,

Feroe²,

Shahein³

et al. 2022

Journal of the Pediatric Orthopaedic Society of North America

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Background: Magnetic resonance imaging (MRI) analysis of the developmental morphology of the anterior cruciate ligament (ACL) in pediatric and adult patients has led to the identification of anatomical risk factors for injury and optimization of surgical reconstruction. Similar work regarding the pediatric posterior cruciate ligament (PCL) is limited. The aim of this study was to describe age-dependent changes in ligamentous and osseous anatomy of the pediatric PCL by comparison of MRI measurements. Methods: Sixty randomly selected patients were categorized into three skeletal age groups (ages 7-9 years, 10-12 years, and 13-15 years) with 20 patients in each. Twelve anatomical dimensions were measured on MRI by two independent reviewers. Pairwise comparisons were conducted between the youngest and intermediate, as well as the intermediate and oldest age groups. Results: Statistically significant growth in femoral physis width (p<0.001), tibial physis width (p<0.001), and medial femoral condyle (MFC) width (p<0.001) and height (p<0.001) was found across all skeletal age groups. Growth in femoral PCL height (p=0.02), femoral PCL footprint to femoral physis height (p=0.004), tibial PCL insertion width (p<0.001), tibial PCL footprint to tibial physis distance (p<0.001), and tibial epiphysis height (p=0.003) and width (p<0.001) was only statistically significant between the youngest and intermediate groups. Only MFC height (p=0.03) and width (p=0.001), femoral PCL height (p=0.05), and tibial physis width (p=0.02) were significantly larger in the oldest compared to the intermediate group. Intrarater reliability for all measurements was excellent; interrater reliability was variable. Conclusions: Morphological changes of the pediatric PCL and associated surgical anatomy vary by skeletal age throughout childhood and adolescence. Differences were most evident between preadolescents with open physes compared to adolescents with closing physes, who demonstrated slowed or plateaued growth in most dimensions. The femoral physis was located proximal to the origin of the PCL in all age groups. The relationship of the distal PCL footprint to posterior proximal tibial physis varied. Young children (7-9 years) had footprints significantly more distal to the tibial physis, thus, native PCL reconstruction in this age group may be possible. Anatomical reconstruction in adolescents poses greater risk as the PCL footprint is closest to the tibial physis. Analysis of age-dependent transformations of the PCL and surrounding anatomy may inform surgical planning and enhance understanding of physeal location in this active population.

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The development of the intercondylar notch in the pediatric population

Cited by 8 publications

References 32 publications

Investigation of Morphometric Factors Associated With Adolescent ACL Rupture

Investigation of Morphometric Factors Associated With Adolescent ACL Rupture

Radiographic reference values of the central knee anatomy in 8–16-year-old children

Age-Related Posterior Cruciate Ligament Surgical Anatomy in a Skeletally Immature Population: An MRI Study

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