Relationship between Femoral Intercondylar Notch Narrowing in Radiography and Anatomical and Histopathologic Integrity of Anterior Cruciate Ligament in Patients Undergoing Total Knee Replacement Surgery

Abstract

Background: The presence of cruciate ligaments is very important for normal knee kinematics. Knee arthroplasty<br />prostheses, in which these ligaments are maintained, have better kinematics. The aim of the present study was to<br />investigate the association between femoral intercondylar notch (FIN) narrowing in radiography and clinical and<br />histopathologic integrity of anterior cruciate ligament (ACL) in patients undergoing knee replacement surgery.<br />Methods: FIN index was measured in tunnel view radiography of the knees of 102 candidates of knee replacement<br />surgery. The anatomical status of ACL was also examined during total knee arthroplasty (TKA). ACL was removed and<br />sent for histopathologic examination to assess its degeneration rate. The association between the FIN index and the<br />clinical and histopathological health of ACL was investigated.<br />Results: Among 102 patients with mean age of 69.73 ± 7.81 years , 39 patients (38.32%) had no or torn ACL, 31<br />patients (30.39%) had weak ACL, and 32 (31.37%) had normal ACL. There was a significant association between age<br />and clinical status of ACL during surgery (P=0.017). There was a significant difference in FIN and ACL health status<br />during surgery between the two groups with an index of more and less than 0.252 (P=0.019 and P=0.019, respectively).<br />There was no significant difference in the mean total degeneration score (TDS) of ACL between the two groups with FIN<br />more and less than 0.252 (P=0.816).<br />Conclusion: There was a significant difference between the age and FIN narrowing (less than 0.252) as well as ACL<br />clinical status during surgery. FIN narrowing had no significant effect on the severity of ACL degeneration and there was<br />no significant difference in the severity of degenerative histopathologic changes between healthy and attenuated ACLs.<br />This indicates that if ACL exists, although apparently attenuated, it has the histologic characteristic of a healthy ligament.<br />Level of evidence: II