Deep lateral femoral notch sign is associated with superficial medial collateral ligament tear in patients with anterior cruciate ligament injury

IF 3.3 Q1 ORTHOPEDICS
Jumpei Inoue MD , Koji Nukuto MD, PhD , Yunseo L. Park BS , Kohei Kamada MD, PhD , Karina Dias MD , Ting Cong MD , Volker Musahl MD
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Abstract

Objectives

The deep lateral femoral notch sign, observed in some anterior cruciate ligament (ACL) injuries, may result from valgus-compressive forces and anterior tibial translation. Since combined ACL and medial collateral ligament (MCL) injuries often involve high valgus torque, we hypothesized an association between MCL tears and the presence of a deep lateral femoral notch sign.

Methods

We conducted a retrospective cohort study of skeletally mature patients (≥14 years) who underwent primary ACL reconstruction (ACLR) and had preoperative MRIs within 3 weeks of injury. Patients were grouped by the presence of a deep lateral femoral notch sign (≥2 ​mm depth). Superficial and deep MCL tears were graded via MRI. Demographics and meniscus surgery data were collected. Univariable and multivariable analyses were used to identify factors associated with the deep lateral femoral notch sign (P ​< ​.050).

Results

Among 590 included patients, 104 (17.6%) had a deep lateral femoral notch sign. Intra- and inter-observer reliability for notch depth and MCL grading showed near-perfect agreement (κ ​> ​0.8). Multivariable analysis identified superficial MCL tear, younger age, and medial posterior tibial bone bruise as independent predictors of a deep lateral femoral notch sign (P ​< ​.001 for all). When stratifying superficial MCL tears, 12.6% of grade 0/I cases and 34.6% of grade II/III cases had deep lateral femoral notch signs. The sign showed 34.6% sensitivity, 87.4% specificity, and an odds ratio of 3.68 (95% CI, 2.35–5.77) for predicting grade II/III superficial MCL tears.

Conclusion

In acute ACL injuries, the deep lateral femoral notch sign is associated with grade II/III superficial MCL tears, showing high specificity and a 3.7-fold increased risk. Its presence should prompt careful assessment of MCL-related instability to optimize patient outcomes.

Level of evidence

Level IV, retrospective cohort study.
前交叉韧带损伤患者的股深外侧切迹与浅内侧副韧带撕裂有关。
目的:在一些前交叉韧带(ACL)损伤中观察到的股深外侧切迹可能是由外翻压缩力和胫骨前平移引起的。由于联合前交叉韧带和内侧副韧带(MCL)损伤通常涉及高外翻扭矩,我们假设MCL撕裂与深外侧股沟征的存在有关。方法:我们对骨骼成熟患者(≥14岁)进行了回顾性队列研究,这些患者接受了原发性ACL重建(ACLR),并在损伤后3周内进行了术前mri检查。根据是否存在深外侧股沟征(≥2mm深度)对患者进行分组。通过MRI对浅、深MCL撕裂进行分级。收集了人口统计学和半月板手术数据。单变量和多变量分析用于确定与股深外侧切迹征相关的因素(P < 0.050)。结果:590例患者中,104例(17.6%)有股深外侧切迹征。缺口深度和MCL分级的观察者内部和观察者之间的信度几乎完全一致(κ > 0.8)。多变量分析发现浅表MCL撕裂、年龄较小和内侧胫骨后骨挫伤是股深外侧切迹的独立预测因素(P < 0.001)。当对浅表MCL撕裂进行分层时,12.6%的0/I级病例和34.6%的II/III级病例有股深外侧切迹征象。该体征预测II/III级浅表性MCL撕裂的敏感性为34.6%,特异性为87.4%,比值比为3.68 (95% CI, 2.35-5.77)。结论:在急性ACL损伤中,股深外侧切迹与II/III级浅表MCL撕裂相关,具有高特异性,风险增加3.7倍。它的存在应该提示仔细评估mcl相关的不稳定性,以优化患者的预后。证据等级:IV级,回顾性队列研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
6.20%
发文量
61
审稿时长
108 days
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