Study finds Importance of Deep lateral femoral notch sign, a
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It was hypothesized that patients with a concomitant ACL/ALL rupture would have an increased DLFNS compared to patients without a concomitant ACL/ALL rupture. The aim of the present study was to investigate the validity and reliability of the deep lateral femoral notch sign (DLFNS) in identifying a concomitant anterior cruciate ligament (ACL)/anterolateral ligament (ALL) rupture and predicting the clinical outcomes following an anatomical single-bundle ACL reconstruction.

The lateral preoperative radiographs and MRI images of 100 patients with an ACL rupture and 100 control subjects were evaluated for the presence of a DLFNS and ACL/ALL rupture, respectively. The patients were evaluated clinically preoperatively and at a minimum 1 year following the ACL reconstruction. A receiver operator curve (ROC) analysis was performed to define the optimal cut-off value of the DLFNS for identifying a concomitant ACL/ALL injury.

Results:
--The prevalence of DLFNS was 52% in the ACL-ruptured patients and 15% in the control group.

--At a minimum 1-year follow-up, 35% of the patients with DLFNS more than 1.8 mm complained of persistent instability, and an MRI evaluation demonstrated a graft re-rupture rate of 12%.

--In patients with a DLFNS less than 1.8 mm, 8% reported a residual instability, and the graft rupture rate was 2.4%.

--A DLFNS more than 1.8 mm demonstrated a sensitivity of 89%, a specificity of 95%, a negative predictive value of 98%, and a positive predictive value of 89% in identifying a concomitant ACL/ALL rupture.

--Patients with a DLFNS more than 1.8 mm had 4.2 times increased risk for residual instability and graft rupture compared to patients with a DLFNS less than 1.8 mm.

Finally, a DLFNS greater than 1.8 mm can be a clinically useful diagnostic method for detecting a concomitant ACL/ALL rupture with high sensitivity and positive predictive value. To prevent residual rotational instability and ACL graft rupture, patients with a DLFNS greater than 1.8 mm should be carefully examined for clinical and radiological signs of a concomitant ACL/ALL rupture and treated as required with a combined intra-articular ACL repair and extra-articular tenodesis.

Source: https://link.springer.com/article/10.1007/s00167-020-06278-w
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