Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis

Nonsimultaneous, bilateral ACL injuries are not uncommon. We studied a group of patients with these injuries to determine possible predisposing factors that could aid in early detection and prevention of contralateral ACL injury. Retrospective analysis of 1,120 patients with ACL ruptures who were treated between 1983 and 1987 revealed 45 patients with bilateral ruptures. Complete follow-up data were available for 41 of these patients. We examined age at initial injury, sex, interval between initial and contralateral ACL injury, mechanism of injury, activity at injury, medical and family histories, treatment of initial injury, and radiographic measurement of intercondylar notch width. The overall incidence of bilaterality was 4.01% in the 28 male and 13 female patients. Their average age was 19 years and 10 months. The average interval between initial and contralateral injury was 47 months. A noncontact cutting maneuver was the most common mechanism of injury. We devised a method to measure and compare intercondylar notch widths on plain radiographs. We compared the mean notch width index (NWI) of the bilateral group to the mean NWI of a group of 50 consecutive patients with "normal" knees and to the mean NWI of 50 consecutive patients with acute ACL ruptures. The mean NWI for the normal group was .2338, for the acute ACL group, .2248, and for the bilateral group, .1961. We noted a statistically significant difference when we compared the bilateral group to the normal and acute groups (P less than 0.0001, respectively). There was no statistically significant difference between the NWI of the normal and acute ACL groups.(ABSTRACT TRUNCATED AT 250 WORDS)