Jumpei Inoue MD , Koji Nukuto MD, PhD , Yunseo L. Park BS , Kohei Kamada MD, PhD , Karina Dias MD , Ting Cong MD , Volker Musahl MD
{"title":"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。","authors":"Jumpei Inoue MD , Koji Nukuto MD, PhD , Yunseo L. Park BS , Kohei Kamada MD, PhD , Karina Dias MD , Ting Cong MD , Volker Musahl MD","doi":"10.1016/j.jisako.2025.100999","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div><div><h3>Level of evidence</h3><div>Level IV, retrospective cohort study.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 100999"},"PeriodicalIF":3.3000,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Deep lateral femoral notch sign is associated with superficial medial collateral ligament tear in patients with anterior cruciate ligament injury\",\"authors\":\"Jumpei Inoue MD , Koji Nukuto MD, PhD , Yunseo L. Park BS , Kohei Kamada MD, PhD , Karina Dias MD , Ting Cong MD , Volker Musahl MD\",\"doi\":\"10.1016/j.jisako.2025.100999\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div><div><h3>Level of evidence</h3><div>Level IV, retrospective cohort study.</div></div>\",\"PeriodicalId\":36847,\"journal\":{\"name\":\"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine\",\"volume\":\"15 \",\"pages\":\"Article 100999\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-09-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2059775425006169\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2059775425006169","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Deep lateral femoral notch sign is associated with superficial medial collateral ligament tear in patients with anterior cruciate ligament injury
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.