THREE-DIMENSIONAL VISUALIZATION OF INTERCONDYLAR NOTCH BASED ON MRI TWO-DIMENSIONAL IMAGES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

lI Yanlin ¹ , XU Peng ^1# , HAN Rui ² , WANG Jianwei ¹ , HE Chuan ¹ , WANG Guoliang ¹ , TONG Lu ¹ , HU Meng ¹

1Department of Sports Medicine, 2Department of Internal Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China. Corresponding author: LI Yanlin, E-mail: yanlinli1969@yahoo.com.cn;

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Keywords：

MRI Three-dimensional reconstruction; Intercondylar notchplasty; Virtual surgery; Anterior cruciate ligament reconstruction

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Objective To study the feasibility of virtual intercondylar notchplasty by applying MRI two-dimensional (2D) images to reconstruct three-dimensional (3D) images and measure the size of intercondylar notch. Methods Thirty healthy volunteers who had no knee joint disease and surgery history were selected. There were 15 females and 15 males with an age range of 20-30 years, weight range of 45-74 kg, and height range of 150-185 cm. They were divided into male group and female group, and the knees of each group were divided into 2 subgroups (the left group and right group). MRI scan of the left and right knees was performed, and the 2D images of MRI were imported into Mimics10.01 medical image control system for 3D reconstruction. The related anatomical data as follows were measured from the 3D digital model and analyzed by statistical software: notch width (NW), condylar width (CW), and notch width index (NWI). Then the 3D knee images of patients with anterior cruciate ligament (ACL) injury were collected between January and March 2010, and 4 patients with narrow intercondylar notch (NWI≤0.2) were selected for reconstructing the 3D model of the knee and simulating the intercondylar notch plasty. Then, the volume of osteotomy in 3D model was calculated and applied in the ACL reconstruction surgery, and whether the graft had impingement with intercondylar notch or not was evaluated. Results There were significant differences in NW and CW between male group and female group (P≤ lt;≤0.05), but no significant difference was found in the NWI (P≤ gt;≤0.05). And there was no significant difference in NW, CW, and NWI between the left and right knees both in male group and female group (P≤ gt;≤0.05). After ACL reconstruction and intercondylar notchplasty, the shape of intercondylar notch became normal (NWI≤ gt;≤0.22), no impingement occurred between the graft and intercondylar notch under arthroscopy within 3-month follow-up. Conclusion The shape of intercondylar notch of 3D model based on MRI 2D images is similar to the real intercondylar notch. NWI is one of important indexes which can reflect the narrow level of intercondylar notch. The virtual intercondylar notchplasty may provide preoperative plan and guidence for ACL reconstruction operation to avoid the impingement between graft and intercondylar notch after surgery.

Citation： lI Yanlin,XU Peng,HAN Rui,WANG Jianwei,HE Chuan,WANG Guoliang,TONG Lu,HU Meng. THREE-DIMENSIONAL VISUALIZATION OF INTERCONDYLAR NOTCH BASED ON MRI TWO-DIMENSIONAL IMAGES. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(10): 1182-1186. doi: Copy

1.	1 韩晓鹏, 纪斌平. 前交叉韧带重建技术的进展. 国际骨科学杂志, 2008, 29(3): 173-176. 2 李健, 董大翠, 余世勇, 等. 股骨髁间窝的应用解剖及其临床研究. 中华实验外科杂志, 2001, 18(2): 140-141.
2.	Vergis A, Gillquist J. Graft failure in intra-articular anterior cruciate ligament reconstructions: a review of the literature. Arthroscopy, 1995, 11(3): 312-321.
3.	Pape D, Seil R, Adam F, et al. Blood loss in anterior cruciate ligament (ACL) reconstruction with and without intercondylar notchplasty: does it affect the clinical outcome? Arch Orthop Trauma Surg, 2001, 121(10): 574-577.
4.	LaPrade RF, Terry GC, Montgomery RD, et al. The effects of aggressive notchplasty on the normal knee in dogs. Am J Sports Med, 1998, 26(2): 193-200.
5.	Asahina S, Muneta T, Ezura Y, et al. Notchplasty in anterior cruciate ligament reconstruction: an experimental animal study? Arthroscopy, 2000, 16(2): 165-172.
6.	Souryal TO, Freemen TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med, 1993, 21(4): 535-539.
7.	Tillman MD, Smith KR, Bauer JA, et al. Differences in three intercondylar notch geometry indices between males and females: a cadaver study. Knee, 2002, 9(1): 41-46.
8.	Van Eck CF, Martins CA, Kopf S, et al. Correlation between the 2-dimensional notch width and the 3-dimensional notch volume: a cadaveric study. Arthroscopy, 2011, 27(2): 207-212.
9.	Osterhoff G, Löffler S, Steinke H, et al. Comparative anatomical measurements of osseous structures in the ovine and human knee. Knee, 2011, 18(2): 98-103.
10.	Shelbourne KD, Gray T, Benner RW, et al. Intercondylar notch width measurement differences between african american and white men and women with intact anterior cruciate ligament knees. Am J Sports Med, 2007, 35(8): 1304-1307.
11.	Simon RA, Everhart JS, Nagaraja HN, et al. A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech, 2010, 43(9): 1702-1707.
12.	Kopf S, Musahl V, Tashman S, et al. A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 213-219.
13.	Colvin AC, Shen W, Musahl V, et al. Avoiding pitfalls in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2009, 17(8): 956-963.
14.	Van de Velde SK, DeFrate LE, Gill TJ, et al. The effect of anterior cruciate ligament deficiency on the in vivo elongation of the medial and lateral collateral ligaments. Am J Sports Med, 2007, 35(2): 294-300.
15.	Suggs J, Wang C, Li G, et al. The effect of graft stiffness on knee joint biomechanics after ACL reconstruction-a 3D computational simulation. Clin Biomech (Bristol, Avon), 2003, 18(1): 35-43.
16.	Hirokawa S, Tsuruno R. Three-dimensional deformation and stress distribution in an analytical/computational model of the anterior cruciate ligament. J Biomech, 2000, 33(9): 1069-1077.
17.	Limbert G, Taylor M, Middleton J, et al. Three-dimensional finite element modelling of the human ACL: simulation of passive knee flexion with a stressed and stress-free ACL. J Biomech, 2004, 37(11): 1723-1731.
18.	胡岩君, 余斌, 苏秀云, 等. 基于MRI、CT影像下膝关节及交叉韧带重建可视化的初步应用研究. 中华创伤骨科杂志, 2007, 9(5): 469-472.
19.	许鹏, 李彦林, 陈文栋, 等. MRI影像下股骨髁间窝三维数字化解剖学数据与实体解剖测量值的差异. 中国组织工程研究与临床康复, 2011, 15(43): 8006-8009.

1. 1 韩晓鹏, 纪斌平. 前交叉韧带重建技术的进展. 国际骨科学杂志, 2008, 29(3): 173-176. 2 李健, 董大翠, 余世勇, 等. 股骨髁间窝的应用解剖及其临床研究. 中华实验外科杂志, 2001, 18(2): 140-141.
2. Vergis A, Gillquist J. Graft failure in intra-articular anterior cruciate ligament reconstructions: a review of the literature. Arthroscopy, 1995, 11(3): 312-321.
3. Pape D, Seil R, Adam F, et al. Blood loss in anterior cruciate ligament (ACL) reconstruction with and without intercondylar notchplasty: does it affect the clinical outcome? Arch Orthop Trauma Surg, 2001, 121(10): 574-577.
4. LaPrade RF, Terry GC, Montgomery RD, et al. The effects of aggressive notchplasty on the normal knee in dogs. Am J Sports Med, 1998, 26(2): 193-200.
5. Asahina S, Muneta T, Ezura Y, et al. Notchplasty in anterior cruciate ligament reconstruction: an experimental animal study? Arthroscopy, 2000, 16(2): 165-172.
6. Souryal TO, Freemen TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med, 1993, 21(4): 535-539.
7. Tillman MD, Smith KR, Bauer JA, et al. Differences in three intercondylar notch geometry indices between males and females: a cadaver study. Knee, 2002, 9(1): 41-46.
8. Van Eck CF, Martins CA, Kopf S, et al. Correlation between the 2-dimensional notch width and the 3-dimensional notch volume: a cadaveric study. Arthroscopy, 2011, 27(2): 207-212.
9. Osterhoff G, Löffler S, Steinke H, et al. Comparative anatomical measurements of osseous structures in the ovine and human knee. Knee, 2011, 18(2): 98-103.
10. Shelbourne KD, Gray T, Benner RW, et al. Intercondylar notch width measurement differences between african american and white men and women with intact anterior cruciate ligament knees. Am J Sports Med, 2007, 35(8): 1304-1307.
11. Simon RA, Everhart JS, Nagaraja HN, et al. A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech, 2010, 43(9): 1702-1707.
12. Kopf S, Musahl V, Tashman S, et al. A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 213-219.
13. Colvin AC, Shen W, Musahl V, et al. Avoiding pitfalls in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2009, 17(8): 956-963.
14. Van de Velde SK, DeFrate LE, Gill TJ, et al. The effect of anterior cruciate ligament deficiency on the in vivo elongation of the medial and lateral collateral ligaments. Am J Sports Med, 2007, 35(2): 294-300.
15. Suggs J, Wang C, Li G, et al. The effect of graft stiffness on knee joint biomechanics after ACL reconstruction-a 3D computational simulation. Clin Biomech (Bristol, Avon), 2003, 18(1): 35-43.
16. Hirokawa S, Tsuruno R. Three-dimensional deformation and stress distribution in an analytical/computational model of the anterior cruciate ligament. J Biomech, 2000, 33(9): 1069-1077.
17. Limbert G, Taylor M, Middleton J, et al. Three-dimensional finite element modelling of the human ACL: simulation of passive knee flexion with a stressed and stress-free ACL. J Biomech, 2004, 37(11): 1723-1731.
18. 胡岩君, 余斌, 苏秀云, 等. 基于MRI、CT影像下膝关节及交叉韧带重建可视化的初步应用研究. 中华创伤骨科杂志, 2007, 9(5): 469-472.
19. 许鹏, 李彦林, 陈文栋, 等. MRI影像下股骨髁间窝三维数字化解剖学数据与实体解剖测量值的差异. 中国组织工程研究与临床康复, 2011, 15(43): 8006-8009.

Chinese Journal of Reparative and Reconstructive Surgery

THREE-DIMENSIONAL VISUALIZATION OF INTERCONDYLAR NOTCH BASED ON MRI TWO-DIMENSIONAL IMAGES

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