Intercondylar Notch Pathology

Abstract

The intercondylar notch of the knee is a relatively small area. However, numerous rare pathologies can arise in this region. A majority of the existing literature has focused on the cruciate ligament injuries, yet there are several other entities that can cause knee pain from within the intercondylar notch. This review focuses on identifying the various diagnostic and treatment options for rare benign and malignant lesions including ganglion cyst formation, mucoid degeneration, benign proliferative conditions, and intra-articular tumors. These entities are most often diagnosed with advanced imaging studies and treated arthroscopically. While rare, these pathologies are important to identify in patients with ongoing vague knee pain.

Keywords

intercondylar notch - ganglion - knee pain

Publication History

Received: 06 July 2022

Accepted: 16 December 2022

Accepted Manuscript online:
20 December 2022

Article published online:
07 February 2023

• References

• 1 Li PK, James SL, Davies AM. Tumour and tumour-like lesions of the intercondylar notch of the knee: a pictorial review. J Med Imaging Radiat Oncol 2008; 52 (05) 434-446
• 2 Friedman RL, Feagin Jr JA. Topographical anatomy of the intercondylar roof. A pilot study. Clin Orthop Relat Res 1994; (306) 163-170
• 3 Koukoubis TD, Glisson RR, Bolognesi M, Vail TP. Dimensions of the intercondylar notch of the knee. Am J Knee Surg 1997; 10 (02) 83-87 , discussion 87–88
• 4 Everhart JS, Flanigan DC, Chaudhari AM. Anteromedial ridging of the femoral intercondylar notch: an anatomic study of 170 archival skeletal specimens. Knee Surg Sports Traumatol Arthrosc 2014; 22 (01) 80-87
• 5 Shelbourne KD, Kerr B. The relationship of femoral intercondylar notch width to height, weight, and sex in patients with intact anterior cruciate ligaments. Am J Knee Surg 2001; 14 (02) 92-96
• 6 Geng B, Wang J, Ma JL. et al. Narrow intercondylar notch and anterior cruciate ligament injury in female nonathletes with knee osteoarthritis aged 41-65 years in plateau region. Chin Med J (Engl) 2016; 129 (21) 2540-2545
• 7 Sutton KM, Bullock JM. Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg 2013; 21 (01) 41-50
• 8 Ireland ML, Ballantyne BT, Little K, McClay IS. A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2001; 9 (04) 200-205
• 9 Anderson AF, Lipscomb AB, Liudahl KJ, Addlestone RB. Analysis of the intercondylar notch by computed tomography. Am J Sports Med 1987; 15 (06) 547-552
• 10 van Eck CF, Martins CA, Vyas SM, Celentano U, van Dijk CN, Fu FH. Femoral intercondylar notch shape and dimensions in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 2010; 18 (09) 1257-1262
• 11 Cerveri P, Marchente M, Manzotti A, Confalonieri N. Determination of the Whiteside line on femur surface models by fitting high-order polynomial functions to cross-section profiles of the intercondylar fossa. Comput Aided Surg 2011; 16 (02) 71-85
• 12 Middleton FR, Palmer SH. How accurate is Whiteside's line as a reference axis in total knee arthroplasty?. Knee 2007; 14 (03) 204-207
• 13 Norman D, Metcalfe AJ, Barlow T. et al. Cortical bony thickening of the lateral intercondylar wall: the functional attachment of the anterior cruciate ligament. Am J Sports Med 2017; 45 (02) 394-402
• 14 Hutchinson MR, Ash SA. Resident's ridge: assessing the cortical thickness of the lateral wall and roof of the intercondylar notch. Arthroscopy 2003; 19 (09) 931-935
• 15 Rhodes LA, Keenan AM, Grainger AJ, Emery P, McGonagle D, Conaghan PG. The relationship between limited MRI section analyses and volumetric assessment of synovitis in knee osteoarthritis. Clin Radiol 2005; 60 (12) 1295-1299
• 16 Vanneuville G, Guillot M, Benedit M, Escande G. The capsulo-synovial folds of the intercondylar fossa of the human knee [in French]. Bull Assoc Anat (Nancy) 1994; 78 (240) 15-17
• 17 Felson DT, Niu J, Neogi T. et al; MOST Investigators Group. Synovitis and the risk of knee osteoarthritis: the MOST Study. Osteoarthritis Cartilage 2016; 24 (03) 458-464
• 18 Chung JW, Lee SH, Han SB, Hwang HJ, Lee DH. A synovial osteochondroma replacing the anterior cruciate ligament at the intercondylar notch. Orthopedics 2011; 34 (02) 136
• 19 Sourlas I, Brilakis E, Mavrogenis A, Stavropoulos N, Korres D. Giant intra-articular synovial osteochondromata of the knee. Hippokratia 2013; 17 (03) 281-283
• 20 Motsis E, Vasiliadis HS, Xenakis TA. Intraarticular synovial lipoma of the knee located in the intercondylar notch, between ACL and PCL: a case report and review of the literature. Knee Surg Sports Traumatol Arthrosc 2005; 13 (08) 683-688
• 21 Fornaciari P, Schai PA, Kurrer MO, Exner GU. Arthroscopic synovectomy in bilateral lipoma arborescens. J Orthop Case Rep 2016; 6 (05) 7-13
• 22 Huang GS, Lee CH, Chan WP, Chen CY, Yu JS, Resnick D. Localized nodular synovitis of the knee: MR imaging appearance and clinical correlates in 21 patients. AJR Am J Roentgenol 2003; 181 (02) 539-543
• 23 Abreu MR, Chung CB, Trudell D, Resnick D. Hoffa's fat pad injuries and their relationship with anterior cruciate ligament tears: new observations based on MR imaging in patients and MR imaging and anatomic correlation in cadavers. Skeletal Radiol 2008; 37 (04) 301-306
• 24 Staeubli HU, Adam O, Becker W, Burgkart R. Anterior cruciate ligament and intercondylar notch in the coronal oblique plane: anatomy complemented by magnetic resonance imaging in cruciate ligament-intact knees. Arthroscopy 1999; 15 (04) 349-359
• 25 Vaswani R, Meredith SJ, Lian J. et al. Intercondylar notch measurement during arthroscopy and on preoperative magnetic resonance imaging. Arthrosc Tech 2019; 8 (10) e1263-e1267
• 26 Nemcić T, Perić P. Ultrasonography of the hip, knee and ankle [in Croatian]. Reumatizam 2010; 57 (02) 81-89
• 27 Podlipská J, Koski JM, Pulkkinen P, Saarakkala S. In vivo quantitative ultrasound image analysis of femoral subchondral bone in knee osteoarthritis. ScientificWorldJournal 2013; 2013: 182562
• 28 Sakthiswary R, Rajalingam S, Hussein H, Sridharan R, Asrul AW. Cartilage oligomeric matrix protein (COMP) in rheumatoid arthritis and its correlation with sonographic knee cartilage thickness and disease activity. Clin Rheumatol 2017; 36 (12) 2683-2688
• 29 Bajaj S, Lopez-Ben R, Oster R, Alarcón GS. Ultrasound detects rapid progression of erosive disease in early rheumatoid arthritis: a prospective longitudinal study. Skeletal Radiol 2007; 36 (02) 123-128
• 30 Haller J, Resnick D, Greenway G. et al. Juxtaacetabular ganglionic (or synovial) cysts: CT and MR features. J Comput Assist Tomogr 1989; 13 (06) 976-983
• 31 Recht MP, Applegate G, Kaplan P. et al. The MR appearance of cruciate ganglion cysts: a report of 16 cases. Skeletal Radiol 1994; 23 (08) 597-600
• 32 Bui-Mansfield LT, Youngberg RA. Intraarticular ganglia of the knee: prevalence, presentation, etiology, and management. AJR Am J Roentgenol 1997; 168 (01) 123-127
• 33 Kim MG, Kim BH, Choi JA. et al. Intra-articular ganglion cysts of the knee: clinical and MR imaging features. Eur Radiol 2001; 11 (05) 834-840
• 34 Kang CN, Kim DW, Kim DJ, Kim SJ. Intra-articular ganglion cysts of the knee. Arthroscopy 1999; 15 (04) 373-378
• 35 Kim RS, Kim KT, Lee JY, Lee KY. Ganglion cysts of the posterior cruciate ligament. Arthroscopy 2003; 19 (06) E36-E40
• 36 Krudwig WK, Schulte KK, Heinemann C. Intra-articular ganglion cysts of the knee joint: a report of 85 cases and review of the literature. Knee Surg Sports Traumatol Arthrosc 2004; 12 (02) 123-129
• 37 Weber D, Friederich NF, Nidecker A, Müller W. Deep posterior knee pain caused by a ganglion of the popliteus tendon–a case report. Knee Surg Sports Traumatol Arthrosc 1996; 4 (03) 157-159
• 38 Jäger A, Eberhardt C, Hailer NP. Large lateral meniscal ganglion cyst extending into the intercondylar fossa of the knee. Arthroscopy 2004; 20 (Suppl. 02) 6-8
• 39 Passler J, Hofer HP, Fellinger M, Peicha G. Intraarticular meniscal cysts of the knee. Report of two cases. Int Orthop 1991; 15 (04) 357-358
• 40 Ohno Y, Itokazu M, Sakaeda H, Iinuma N, Shima H. Meniscal cyst in the posterior intercondylar space found by magnetic resonance imaging. Arch Orthop Trauma Surg 1998; 117 (6–7): 394-396
• 41 Brown MF, Dandy DJ. Intra-articular ganglia in the knee. Arthroscopy 1990; 6 (04) 322-323
• 42 Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. AJR Am J Roentgenol 2004; 182 (05) 1283-1287
• 43 Jawish R, Nemer C, Assoum H, Haddad A. Ganglion cyst of the anterior cruciate ligament in children. J Pediatr Orthop B 2009; 18 (05) 234-237
• 44 Janzen DL, Peterfy CG, Forbes JR, Tirman PF, Genant HK. Cystic lesions around the knee joint: MR imaging findings. AJR Am J Roentgenol 1994; 163 (01) 155-161
• 45 Maffulli N, Binfield PM, King JB. Isolated ganglions of the anterior cruciate ligament. Med Sci Sports Exerc 1993; 25 (05) 550-553
• 46 McLaren DB, Buckwalter KA, Vahey TN. The prevalence and significance of cyst-like changes at the cruciate ligament attachments in the knee. Skeletal Radiol 1992; 21 (06) 365-369
• 47 Deutsch A, Veltri DM, Altchek DW, Potter HG, Warren RF, Wickiewicz TL. Symptomatic intraarticular ganglia of the cruciate ligaments of the knee. Arthroscopy 1994; 10 (02) 219-223
• 48 Johnson WL, Corzatt RD. Ganglion cyst of the anterior cruciate ligament. A case report of an unusual cause of mechanical knee symptoms. Am J Sports Med 1993; 21 (06) 893-894
• 49 Shetty GM, Nha KW, Patil SP. et al. Ganglion cysts of the posterior cruciate ligament. Knee 2008; 15 (04) 325-329
• 50 Huang GS, Lee CH, Chan WP. et al. Ganglion cysts of the cruciate ligaments. Acta Radiol 2002; 43 (04) 419-424
• 51 Fealy S, Kenter K, Dines JS, Warren RF. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy 2001; 17 (09) E37
• 52 Stäbler A, Glaser C, Reiser M. Musculoskeletal MR: knee. Eur Radiol 2000; 10 (02) 230-241
• 53 Steiner E, Steinbach LS, Schnarkowski P, Tirman PF, Genant HK. Ganglia and cysts around joints. Radiol Clin North Am 1996; 34 (02) 395-425 , xi–xii
• 54 Calmet J, Hernández-Hermoso J, Giné J, Jimeno F. Localized pigmented villonodular synovitis in an unusual location in the knee. Arthroscopy 2003; 19 (02) 144-149
• 55 Saha P, Bandyopadhyay U, Mukhopadhyay AS, Kundu S, Mandal S. Ganglion cyst of knee from Hoffa's fat pad protruding anterolaterally through retinacular rent: a case report. J Orthop Case Rep 2015; 5 (03) 69-71
• 56 Calvisi V, Collodel M, Romanini L. Synovial ganglia of the central pivot of the knee. Ital J Orthop Traumatol 1991; 17 (03) 305-311
• 57 Sarimo J, Rantanen J, Helttula I, Orava S. Intra-articular cysts and ganglia of the knee: a report of nine patients. Knee Surg Sports Traumatol Arthrosc 2005; 13 (01) 44-47
• 58 Andrikoula SI, Vasiliadis HS, Tokis AV, Kosta P, Batistatou A, Georgoulis AD. Intra-articular ganglia of the knee joint associated with the anterior cruciate ligament: a report of 4 cases in 3 patients. Arthroscopy 2007; 23 (07) 800.e1-800.e6
• 59 Lintz F, Pujol N, Boisrenoult P, Bargoin K, Beaufils P, Dejour D. Anterior cruciate ligament mucoid degeneration: a review of the literature and management guidelines. Knee Surg Sports Traumatol Arthrosc 2011; 19 (08) 1326-1333
• 60 Narvekar A, Gajjar S. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy 2004; 20 (02) 141-146
• 61 Motmans R, Verheyden F. Mucoid degeneration of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2009; 17 (07) 737-740
• 62 McIntyre J, Moelleken S, Tirman P. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Skeletal Radiol 2001; 30 (06) 312-315
• 63 Morice A, Coupry A, Lintz F, Robert H. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Orthop Traumatol Surg Res 2013; 99 (06) 693-697
• 64 Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin SI. Arthroscopic treatment of mucoid hypertrophy of the anterior cruciate ligament. Arthroscopy 2008; 24 (06) 642-649
• 65 Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: selecting the best treatment option. Orthop Traumatol Surg Res 2010; 96 (04) 400-406
• 66 Chudasama CH, Chudasama VC, Prabhakar MM. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Indian J Orthop 2012; 46 (05) 561-565
• 67 Wittkop B, Davies AM, Mangham DC. Primary synovial chondromatosis and synovial chondrosarcoma: a pictorial review. Eur Radiol 2002; 12 (08) 2112-2119
• 68 Neumann JA, Garrigues GE, Brigman BE, Eward WC. Synovial chondromatosis. JBJS Rev 2016; 4 (05) e2
• 69 Llauger J, Palmer J, Rosón N, Cremades R, Bagué S. Pigmented villonodular synovitis and giant cell tumors of the tendon sheath: radiologic and pathologic features. AJR Am J Roentgenol 1999; 172 (04) 1087-1091
• 70 González-Lois C, García-de-la-Torre P, SantosBriz-Terrón A, Vilá J, Manrique-Chico J, Martínez-Tello J. Intracapsular and para-articular chondroma adjacent to large joints: report of three cases and review of the literature. Skeletal Radiol 2001; 30 (12) 672-676
• 71 Steiner GC, Meushar N, Norman A, Present D. Intracapsular and paraarticular chondromas. Clin Orthop Relat Res 1994; (303) 231-236
• 72 Milgram JW, Dunn EJ. Para-articular chondromas and osteochondromas: a report of three cases. Clin Orthop Relat Res 1980; (148) 147-151
• 73 Hagan PF, Schoenecker PL. Para-articular osteochondroma. Am J Orthop 1995; 24 (01) 65-67
• 74 Ishida T, Iijima T, Moriyama S, Nakamura C, Kitagawa T, Machinami R. Intra-articular calcifying synovial sarcoma mimicking synovial chondromatosis. Skeletal Radiol 1996; 25 (08) 766-769
• 75 McLain R, Buckwalter J, Platz CE. Synovial sarcoma of the knee: missed diagnosis despite biopsy and arthroscopic synovectomy. A case report. J Bone Joint Surg Am 1990; 72 (07) 1092-1094
• 76 McKinney CD, Mills SE, Fechner RE. Intraarticular synovial sarcoma. Am J Surg Pathol 1992; 16 (10) 1017-1020
• 77 Friedman MV, Kyriakos M, Matava MJ, McDonald DJ, Jennings JW, Wessell DE. Intra-articular synovial sarcoma. Skeletal Radiol 2013; 42 (06) 859-867
• 78 Taconis WK, van der Heul RO, Taminiau AM. Synovial chondrosarcoma: report of a case and review of the literature. Skeletal Radiol 1997; 26 (11) 682-685
• 79 Davis RI, Hamilton A, Biggart JD. Primary synovial chondromatosis: a clinicopathologic review and assessment of malignant potential. Hum Pathol 1998; 29 (07) 683-688
• 80 Levine HR, Tingle E, Carter B, Dockery D. Synovial metastasis from lung cancer. Proc Bayl Univ Med Cent 2013; 26 (01) 25-27