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Citation:
Lustosa L, Knipe H, Notch width index. Reference article, Radiopaedia.org (Accessed on 16 May 2024) https://doi.org/10.53347/rID-172890
The notch width index (NWI) is a measurement that has been proposed as a possible indicator of the risk of anterior cruciate ligament injuries 5.
The NWI is assessed on the tunnel view radiograph of the knee as the ratio between the width of the intercondylar notch and the width of the femur. These measurements are made at the level of the popliteal groove and parallel to the joint line 1,2.
Alternatively, the measurement can be performed on a coronal MRI sequence 4-8.
There are many conflicting reports regarding the actual relevance of the NWI as a predictor of ACL injuries. While some studies suggest that a narrower NWI is associated with a higher risk of ACL injuries 1,2, others have concluded that the NWI alone is not a reliable predictor for such injuries 3,4.
The most extensive meta-analysis to date (c.2023) has found that NWI was lower in ACL injury cases among men 5.
A proposed limit for which the NWI would be considered a critical indicator of risk for ACL injuries has been <0.20 (males) and <0.18 (females) 2.
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1. Souryal T, Moore H, Evans J. Bilaterality in Anterior Cruciate Ligament Injuries. Am J Sports Med. 1988;16(5):449-54. doi:10.1177/036354658801600504 - Pubmed
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2. Souryal T & Freeman T. Intercondylar Notch Size and Anterior Cruciate Ligament Injuries in Athletes. Am J Sports Med. 1993;21(4):535-9. doi:10.1177/036354659302100410 - Pubmed
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3. Teitz C, Lind B, Sacks B. Symmetry of the Femoral Notch Width Index. Am J Sports Med. 1997;25(5):687-90. doi:10.1177/036354659702500517 - Pubmed
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4. Al-Saeed O, Brown M, Athyal R, Sheikh M. Association of Femoral Intercondylar Notch Morphology, Width Index and the Risk of Anterior Cruciate Ligament Injury. Knee Surg Sports Traumatol Arthrosc. 2012;21(3):678-82. doi:10.1007/s00167-012-2038-y - Pubmed
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5. Li Z, Li C, Li L, Wang P. Correlation Between Notch Width Index Assessed via Magnetic Resonance Imaging and Risk of Anterior Cruciate Ligament Injury: An Updated Meta-Analysis. Surg Radiol Anat. 2020;42(10):1209-17. doi:10.1007/s00276-020-02496-6 - Pubmed
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6. Park J, Nam D, Kim D, Kim H, Hwang S. Measurement of Knee Morphometrics Using MRI: A Comparative Study Between ACL-Injured and Non-Injured Knees. Knee Surg Relat Res. 2012;24(3):180-5. doi:10.5792/ksrr.2012.24.3.180 - Pubmed
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7. Taneja A, Miranda F, Demange M et al. Evaluation of Posterior Cruciate Ligament and Intercondylar Notch in Subjects With Anterior Cruciate Ligament Tear: A Comparative Flexed-Knee 3D Magnetic Resonance Imaging Study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018;34(2):557-65. doi:10.1016/j.arthro.2017.08.296 - Pubmed
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8. Whitney D, Sturnick D, Vacek P et al. Relationship Between the Risk of Suffering a First-Time Noncontact ACL Injury and Geometry of the Femoral Notch and ACL. Am J Sports Med. 2014;42(8):1796-805. doi:10.1177/0363546514534182 - Pubmed
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