Research progress of lateral femoral notch sign in diagnosis of anterior cruciate ligament rupture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GONG Heng ^1,2 , QIAO Xinrong ^1,3 ,  CHEN Lianxu ^1,2

1. School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China;
2. Department of Orthopedics, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China;
3. Department of Radiology, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China;

Corresponding author：

CHEN Lianxu, Email: bjchenlx69@163.com

Keywords：

Lateral femoral notch sign; anterior cruciate ligament rupture; MRI; diagnosis; research progress

DOI：

10.7507/1002-1892.202104078

Video：

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Objective To summarize the relationship between lateral femoral notch sign (LFNS) and anterior cruciate ligament (ACL) rupture. Methods The relevant literature of LFNS at home and abroad in recent years was retrospectively reviewed, and its mechanism, diagnostic criteria and influencing factors in diagnosis of ACL rupture were summarized and analyzed.Results The LFNS is associated with rotational stability of the knee. As an indirect sign of ACL rupture, the LFNS has high clinical diagnostic value, especially the diagnosis of ACL rupture with lateral meniscus injury.Conclusion The diagnostic criteria and influencing factors of LFNS in diagnosis of ACL rupture are still unclear and controversial, which needs further study.

Citation： GONG Heng, QIAO Xinrong, CHEN Lianxu. Research progress of lateral femoral notch sign in diagnosis of anterior cruciate ligament rupture. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(9): 1200-1204. doi: 10.7507/1002-1892.202104078 Copy

1.	陈连旭, 付立功. 前交叉韧带断裂和重建的临床流行病学分析. 中国组织工程研究, 2016, 20(24): 3602-3608.
2.	周根泉, 张悦萍, 张贵祥, 等. 膝关节前交叉韧带撕裂的MRI诊断. 中国医学影像技术, 2002, 18(11): 1146-1149.
3.	Cobby MJ, Schweitzer ME, Resnick D. The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament. Radiology, 1992, 184(3): 855-858.
4.	Gentili A, Seeger LL, Yao L, et al. Anterior cruciate ligament tear: indirect signs at MR imaging. Radiology, 1994, 193(3): 835-840.
5.	郑卓肇, 范家栋, 吕兴隆. 前交叉韧带损伤: MRI多征象分析. 中国医学影像技术, 2004, 20(9): 1311-1314.
6.	Nakauchi M, Kurosawa H, Kawakami A. Abnormal lateral notch in knees with anterior cruciate ligament injury. J Orthop Sci, 2000, 5(2): 92-95.
7.	Takai S, Woo SL, Livesay GA, et al. Determination of the in situ loads on the human anterior cruciate ligament. J Orthop Res, 1993, 11(5): 686-695.
8.	Chambat P. ACL tear. Orthop Traumatol Surg Res, 2013, 99(1 Suppl): S43-S52.
9.	Shimokochi Y, Shultz SJ. Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train, 2008, 43(4): 396-408.
10.	Torabi M, Fu F, Luo J, et al. Clinical relevance and imaging features of isolated single bundle anterior cruciate tear and single bundle augmentation. Clin Imag, 2013, 37(5): 830-835.
11.	郑卓肇. 膝关节的MRI检查//杨正汉, 冯逢, 王霄英, 等. 磁共振成像技术指南——检查规范、临床策略及新技术应用. 北京: 人民军医出版社, 2007: 705.
12.	Saxena A, Ray B, Rajagopal KV, et al. Morphometry and magnetic resonance imaging of anterior cruciate ligament and measurement of secondary signs of anterior cruciate ligament tear. Bratisl Lek Listy, 2012, 113(9): 539-543.
13.	Siwiński D, Ziemiański A. Value of posterior cruciate ligament index in the diagnosis of anterior cruciate ligament injuries. Arch Orthop Trauma Surg, 1998, 118(1-2): 116-118.
14.	Kang H, Fu K, Dong C, et al. The patellar tendon wavy sign as a new secondary sign of ACL tear on MRI. Acta Orthop Traumatol Turc, 2018, 52(5): 372-375.
15.	程相允, 张升校, 路雁惠, 等. 胫骨平台前外侧撕脱骨折合并前交叉韧带损伤的诊治. 中华关节外科杂志 (电子版), 2018, 12(4): 534-538.
16.	Guenoun D, Le Corroller T, Amous Z, et al. The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament. Diagn Interv Imaging, 2012, 93(5): 331-341.
17.	Speer KP, Warren RF, Wickiewicz TL, et al. Observations on the injury mechanism of anterior cruciate ligament tears in skiers. Am J Sports Med, 1995, 23(1): 77-81.
18.	Garth WP, Greco J, House MA. The lateral notch sign associated with acute anterior cruciate ligament disruption. Am J Sports Med, 2000, 28(1): 68-73.
19.	Grimberg A, Shirazian H, Torshizy H, et al. Deep lateral notch sign and double notch sign in complete tears of the anterior cruciate ligament: MR imaging evaluation. Skeletal Radiol, 2015, 44(3): 385-391.
20.	Kanakamedala AC, Burnham JM, Pfeiffer TR, et al. Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1399-1405.
21.	Lucidi GA, Grassi A, Di Paolo S, et al. The lateral femoral Notch sign is correlated with increased rotatory laxity after anterior cruciate ligament injury: pivot shift quantification with a surgical navigation system. Am J Sports Med, 2021, 49(3): 649-655.
22.	Miller LS, Yu JS. Radiographic indicators of acute ligament injuries of the knee: a mechanistic approach. Emerg Radiol, 2010, 17(6): 435-444.
23.	Hoffelner T, Pichler I, Moroder P, et al. Segmentation of the lateral femoral notch sign with MRI using a new measurement technique. BMC Musculoskelet Disord, 2015, 16: 217. doi: 10.1186/s12891-015-0677-0.
24.	Murphy BJ, Smith RL, Uribe JW, et al. Bone signal abnormalities in the posterolateral tibia and lateral femoral condyle in complete tears of the anterior cruciate ligament: a specific sign? Radiology, 1992, 182(1): 221-224.
25.	Lodewijks PCAM, Delawi D, Bollen TL, et al. The lateral femoral notch sign: a reliable diagnostic measurement in acute anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 659-664.
26.	Pao DG. The lateral femoral notch sign. Radiology, 2001, 219(3): 800-801.
27.	Yu J S, Bosch E, Pathria MN, et al. Deep lateral femoral sulcus: study of 124 patients with anterior cruciate ligament tear. Emerg Radiol, 1995, 2: 129-134.
28.	Wierer G, Simetinger T, Hudelmaier M, et al. Fate of the lateral femoral notch following early anterior cruciate ligament reconstruction. Knee, 2020, 27(2): 414-419.
29.	Herbst E, Hoser C, Tecklenburg K, et al. The lateral femoral notch sign following ACL injury: frequency, morphology and relation to meniscal injury and sports activity. Knee Surg Sports Traumatol Arthrosc, 2015, 23(8): 2250-2258.
30.	Mesgarzadeh M, Schneck CD, Bonakdarpour A. Magnetic resonance imaging of the knee and correlation with normal anatomy. Radiographics, 1988, 8(4): 707-733.
31.	Behzadi C, Welsch GH, Petersen JP, et al. T2 relaxation times of the anterolateral femoral cartilage in patients after ACL-reconstruction with and without a deep lateral femoral notch sign. Eur J Radiol, 2018, 106: 85-91.
32.	Choi WR, Yang JH, Jeong SY, et al. MRI comparison of injury mechanism and anatomical factors between sexes in non-contact anterior cruciate ligament injuries. PLoS One, 2019, 14(8): e0219586. doi: 10.1371/journal.pone.0219586.
33.	Patel SA, Hageman J, Quatman CE, et al. Prevalence and location of bone bruises associated with anterior cruciate ligament injury and implications for mechanism of injury: a systematic review. Sports Med, 2014, 44(2): 281-293.
34.	Nakamae A, Engebretsen L, Bahr R, et al. Natural history of bone bruises after acute knee injury: clinical outcome and histopathological findings. Knee Surg Sports Traumatol Arthrosc, 2006, 14(12): 1252-1258.
35.	Sadlo PA, Nebelung W. Arthroscopically assisted reduction of a lateral femoral notch in acute tear of the anterior cruciate ligament. Arthroscopy, 2006, 22(5): 574.e1-3.
36.	Tauber M, Fox M, Koller H, et al. Arthroscopic treatment of a large lateral femoral notch in acute anterior cruciate ligament tear. Arch Orthop Trauma Surg, 2008, 128(11): 1313-1316.
37.	Fayad LM, Parellada JA, Parker L, et al. MR imaging of anterior cruciate ligament tears: is there a gender gap? Skeletal Radiol, 2003, 32(11): 639-646.
38.	Berthold DP, Muench LN, Herbst E, et al. High prevalence of a deep lateral femoral notch sign in patients with anterior cruciate ligament (ACL) and concomitant posterior root tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc, 2021, 29(4): 1018-1024.
39.	Dimitriou D, Reimond M, Foesel A, et al. The deep lateral femoral notch sign: a reliable diagnostic tool in identifying a concomitant anterior cruciate and anterolateral ligament injury. Knee Surg Sports Traumatol Arthrosc, 2021, 29(6): 1968-1976.

1. 陈连旭, 付立功. 前交叉韧带断裂和重建的临床流行病学分析. 中国组织工程研究, 2016, 20(24): 3602-3608.
2. 周根泉, 张悦萍, 张贵祥, 等. 膝关节前交叉韧带撕裂的MRI诊断. 中国医学影像技术, 2002, 18(11): 1146-1149.
3. Cobby MJ, Schweitzer ME, Resnick D. The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament. Radiology, 1992, 184(3): 855-858.
4. Gentili A, Seeger LL, Yao L, et al. Anterior cruciate ligament tear: indirect signs at MR imaging. Radiology, 1994, 193(3): 835-840.
5. 郑卓肇, 范家栋, 吕兴隆. 前交叉韧带损伤: MRI多征象分析. 中国医学影像技术, 2004, 20(9): 1311-1314.
6. Nakauchi M, Kurosawa H, Kawakami A. Abnormal lateral notch in knees with anterior cruciate ligament injury. J Orthop Sci, 2000, 5(2): 92-95.
7. Takai S, Woo SL, Livesay GA, et al. Determination of the in situ loads on the human anterior cruciate ligament. J Orthop Res, 1993, 11(5): 686-695.
8. Chambat P. ACL tear. Orthop Traumatol Surg Res, 2013, 99(1 Suppl): S43-S52.
9. Shimokochi Y, Shultz SJ. Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train, 2008, 43(4): 396-408.
10. Torabi M, Fu F, Luo J, et al. Clinical relevance and imaging features of isolated single bundle anterior cruciate tear and single bundle augmentation. Clin Imag, 2013, 37(5): 830-835.
11. 郑卓肇. 膝关节的MRI检查//杨正汉, 冯逢, 王霄英, 等. 磁共振成像技术指南——检查规范、临床策略及新技术应用. 北京: 人民军医出版社, 2007: 705.
12. Saxena A, Ray B, Rajagopal KV, et al. Morphometry and magnetic resonance imaging of anterior cruciate ligament and measurement of secondary signs of anterior cruciate ligament tear. Bratisl Lek Listy, 2012, 113(9): 539-543.
13. Siwiński D, Ziemiański A. Value of posterior cruciate ligament index in the diagnosis of anterior cruciate ligament injuries. Arch Orthop Trauma Surg, 1998, 118(1-2): 116-118.
14. Kang H, Fu K, Dong C, et al. The patellar tendon wavy sign as a new secondary sign of ACL tear on MRI. Acta Orthop Traumatol Turc, 2018, 52(5): 372-375.
15. 程相允, 张升校, 路雁惠, 等. 胫骨平台前外侧撕脱骨折合并前交叉韧带损伤的诊治. 中华关节外科杂志 (电子版), 2018, 12(4): 534-538.
16. Guenoun D, Le Corroller T, Amous Z, et al. The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament. Diagn Interv Imaging, 2012, 93(5): 331-341.
17. Speer KP, Warren RF, Wickiewicz TL, et al. Observations on the injury mechanism of anterior cruciate ligament tears in skiers. Am J Sports Med, 1995, 23(1): 77-81.
18. Garth WP, Greco J, House MA. The lateral notch sign associated with acute anterior cruciate ligament disruption. Am J Sports Med, 2000, 28(1): 68-73.
19. Grimberg A, Shirazian H, Torshizy H, et al. Deep lateral notch sign and double notch sign in complete tears of the anterior cruciate ligament: MR imaging evaluation. Skeletal Radiol, 2015, 44(3): 385-391.
20. Kanakamedala AC, Burnham JM, Pfeiffer TR, et al. Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis. Knee Surg Sports Traumatol Arthrosc, 2018, 26(5): 1399-1405.
21. Lucidi GA, Grassi A, Di Paolo S, et al. The lateral femoral Notch sign is correlated with increased rotatory laxity after anterior cruciate ligament injury: pivot shift quantification with a surgical navigation system. Am J Sports Med, 2021, 49(3): 649-655.
22. Miller LS, Yu JS. Radiographic indicators of acute ligament injuries of the knee: a mechanistic approach. Emerg Radiol, 2010, 17(6): 435-444.
23. Hoffelner T, Pichler I, Moroder P, et al. Segmentation of the lateral femoral notch sign with MRI using a new measurement technique. BMC Musculoskelet Disord, 2015, 16: 217. doi: 10.1186/s12891-015-0677-0.
24. Murphy BJ, Smith RL, Uribe JW, et al. Bone signal abnormalities in the posterolateral tibia and lateral femoral condyle in complete tears of the anterior cruciate ligament: a specific sign? Radiology, 1992, 182(1): 221-224.
25. Lodewijks PCAM, Delawi D, Bollen TL, et al. The lateral femoral notch sign: a reliable diagnostic measurement in acute anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 659-664.
26. Pao DG. The lateral femoral notch sign. Radiology, 2001, 219(3): 800-801.
27. Yu J S, Bosch E, Pathria MN, et al. Deep lateral femoral sulcus: study of 124 patients with anterior cruciate ligament tear. Emerg Radiol, 1995, 2: 129-134.
28. Wierer G, Simetinger T, Hudelmaier M, et al. Fate of the lateral femoral notch following early anterior cruciate ligament reconstruction. Knee, 2020, 27(2): 414-419.
29. Herbst E, Hoser C, Tecklenburg K, et al. The lateral femoral notch sign following ACL injury: frequency, morphology and relation to meniscal injury and sports activity. Knee Surg Sports Traumatol Arthrosc, 2015, 23(8): 2250-2258.
30. Mesgarzadeh M, Schneck CD, Bonakdarpour A. Magnetic resonance imaging of the knee and correlation with normal anatomy. Radiographics, 1988, 8(4): 707-733.
31. Behzadi C, Welsch GH, Petersen JP, et al. T2 relaxation times of the anterolateral femoral cartilage in patients after ACL-reconstruction with and without a deep lateral femoral notch sign. Eur J Radiol, 2018, 106: 85-91.
32. Choi WR, Yang JH, Jeong SY, et al. MRI comparison of injury mechanism and anatomical factors between sexes in non-contact anterior cruciate ligament injuries. PLoS One, 2019, 14(8): e0219586. doi: 10.1371/journal.pone.0219586.
33. Patel SA, Hageman J, Quatman CE, et al. Prevalence and location of bone bruises associated with anterior cruciate ligament injury and implications for mechanism of injury: a systematic review. Sports Med, 2014, 44(2): 281-293.
34. Nakamae A, Engebretsen L, Bahr R, et al. Natural history of bone bruises after acute knee injury: clinical outcome and histopathological findings. Knee Surg Sports Traumatol Arthrosc, 2006, 14(12): 1252-1258.
35. Sadlo PA, Nebelung W. Arthroscopically assisted reduction of a lateral femoral notch in acute tear of the anterior cruciate ligament. Arthroscopy, 2006, 22(5): 574.e1-3.
36. Tauber M, Fox M, Koller H, et al. Arthroscopic treatment of a large lateral femoral notch in acute anterior cruciate ligament tear. Arch Orthop Trauma Surg, 2008, 128(11): 1313-1316.
37. Fayad LM, Parellada JA, Parker L, et al. MR imaging of anterior cruciate ligament tears: is there a gender gap? Skeletal Radiol, 2003, 32(11): 639-646.
38. Berthold DP, Muench LN, Herbst E, et al. High prevalence of a deep lateral femoral notch sign in patients with anterior cruciate ligament (ACL) and concomitant posterior root tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc, 2021, 29(4): 1018-1024.
39. Dimitriou D, Reimond M, Foesel A, et al. The deep lateral femoral notch sign: a reliable diagnostic tool in identifying a concomitant anterior cruciate and anterolateral ligament injury. Knee Surg Sports Traumatol Arthrosc, 2021, 29(6): 1968-1976.

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