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Published on: September 2, 2025
Computed Tomography-Based Morphometric Analysis Reveals Intercondylar Notch Stenosis and Osteophytes Are Associated
Xiaozhong Ma1, WenMing Jiang1, Chao Lu2
1The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
Purpose:
To quantitatively assess intercondylar notch morphometrics using 3-dimensional computed tomography reconstruction, evaluate their association with anterior cruciate ligament (ACL) injury in Asian populations, and investigate the prevalence of osteophytes in patients with ACL injury.
Methods:
This retrospective study included patients aged 18 to 50 years with knee symptoms who underwent magnetic resonance imaging and computed tomography at our hospital between September 2023 and September 2024. Exclusion criteria included moderate-to-severe osteoarthritis (Kellgren-Lawrence grade ≥2), multiligament injuries, and prior knee surgery. Patients were divided into ACL injury and non-ACL injury groups. Computed tomography parameters included notch width index, notch width, notch height, bicondylar width, notch angle, β angle, and osteophytes. Reliability was assessed using the intraclass correlation coefficient. Group comparisons and associations were evaluated using appropriate parametric/nonparametric tests, χ2 tests, and univariate/multivariable logistic regression, with multicollinearity diagnostics and model performance evaluation (including receiver operating characteristic curve analysis, calibration/discrimination, incremental value, sensitivity analysis, nomogram construction, decision curve analysis, and SHapley Additive exPlanations analysis).
Results:
In total, 146 patients with activity-related knee discomfort (ACL injury, n = 83; controls, n = 63) were included. Intraobserver and interobserver reliability were excellent (intraclass correlation coefficients 0.95-0.98 and 0.98-0.99, respectively). Osteophytes (odds ratio [OR] = 7.41; 95% confidence interval, 2.89-18.98; P < .001), age (OR = 0.940; P < .05), notch angle (OR = 0.84; P < .001), and β angle (OR = 1.15; P = .02) were associated with ACL injury. Receiver operating characteristic curve analysis showed the full model, including osteophytes (area under the curve = 0.86), outperformed the model without osteophytes (area under the curve = 0.81). Sex was not associated with osteophyte incidence or notch width index (P > .05). Weight, height, notch height, and bicondylar width were not associated with ACL injury (P > .05).
Conclusions:
This study showed that specific intercondylar notch morphometric features, particularly osteophytes and notch angle, were strongly associated with ACL injury in this Asian cohort. β angle, notch width index, and age were also associated with ACL injury.
Level Of Evidence:
Level III, case-control study.
