Introduction: The lateral notch sign (LNS) is a depression of the lateral femoral condyle, visible on X-ray in lateral view, determined by the impact of the condyle with the region of the upper postero-lateral tibial plateau during knee sprains that cause ACL tear. Aim of this study is to perform a comparative evaluation of LNS on X-rays of patients with ACL injury. The hypothesis of the study are: the LNS is an indirect radiographic sign of ACL injury; there is no inter-and intra-individual variability in the evaluation of the LNS; the LNS is associated with a specific type of knee trauma; the LNS is associated with meniscal lesions. Materials and Methods: 80 consecutive patients with ACL tear were included In the study. X-rays of both knees were performed before surgery. The LNS was measured by drawing the perpendicular to the tangent of the depression of the condyle. Nakauchi classification was adopeted to evaluate the LNS type. The frequency and depth of the LNS was evaluated independently by two residents of the first year of orthopaedics course. Three evaluations were performed, at a distance of one week from each other, by one of the observers randomly chosen. The results were correlated with the type of mechanism of trauma, the presence of meniscal tears, the age, sex and the sport practiced by the patient at the time of trauma. Results: the frequency of the LNS was for single observer 36 of 80 patients (45%) and 34 of 80 patients (42.5%) respectively (p> 0.05). The average depth was 1.3 mm (range, 0.5 - 2.9 mm) and 1.2 mm (range, 0.5 - 2.9 mm) (p> 0.05). There were no significant differences in the classification of the LNS and the three different measurements of the individual operator. The LNS was associated mainly with valgus and external rotation trauma injury and to the lateral meniscal tear (p <0.05). There were no correlations between LNS and other variables. Discussion: The LNS is an reliable and easily detectable indirect radiographic sign of ACL tear. The association of valgus and external rotation trauma with LNS and the positive clinic signs of lateral meniscus tear supports the hypothesis of ACL rupture. Conclusion: Future goal is to continue long-term study of the same patients to assess the possible clinical and radiographic degenerative changes of this lesion.

Comparative evaluation of the lateral notch sign in patients with anterior cruciate ligament tear

RONGA, MARIO;
2012-01-01

Abstract

Introduction: The lateral notch sign (LNS) is a depression of the lateral femoral condyle, visible on X-ray in lateral view, determined by the impact of the condyle with the region of the upper postero-lateral tibial plateau during knee sprains that cause ACL tear. Aim of this study is to perform a comparative evaluation of LNS on X-rays of patients with ACL injury. The hypothesis of the study are: the LNS is an indirect radiographic sign of ACL injury; there is no inter-and intra-individual variability in the evaluation of the LNS; the LNS is associated with a specific type of knee trauma; the LNS is associated with meniscal lesions. Materials and Methods: 80 consecutive patients with ACL tear were included In the study. X-rays of both knees were performed before surgery. The LNS was measured by drawing the perpendicular to the tangent of the depression of the condyle. Nakauchi classification was adopeted to evaluate the LNS type. The frequency and depth of the LNS was evaluated independently by two residents of the first year of orthopaedics course. Three evaluations were performed, at a distance of one week from each other, by one of the observers randomly chosen. The results were correlated with the type of mechanism of trauma, the presence of meniscal tears, the age, sex and the sport practiced by the patient at the time of trauma. Results: the frequency of the LNS was for single observer 36 of 80 patients (45%) and 34 of 80 patients (42.5%) respectively (p> 0.05). The average depth was 1.3 mm (range, 0.5 - 2.9 mm) and 1.2 mm (range, 0.5 - 2.9 mm) (p> 0.05). There were no significant differences in the classification of the LNS and the three different measurements of the individual operator. The LNS was associated mainly with valgus and external rotation trauma injury and to the lateral meniscal tear (p <0.05). There were no correlations between LNS and other variables. Discussion: The LNS is an reliable and easily detectable indirect radiographic sign of ACL tear. The association of valgus and external rotation trauma with LNS and the positive clinic signs of lateral meniscus tear supports the hypothesis of ACL rupture. Conclusion: Future goal is to continue long-term study of the same patients to assess the possible clinical and radiographic degenerative changes of this lesion.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11695/62947
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