{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:02:11Z","timestamp":1789844531201,"version":"4.0.1"},"reference-count":37,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,12,28]],"date-time":"2025-12-28T00:00:00Z","timestamp":1766880000000},"content-version":"vor","delay-in-days":88,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The aim of this study was to investigate the prevalence of the deep lateral femoral notch sign (DLFNS) in skeletally immature patients with anterior cruciate ligament (ACL) injuries and its potential association with trauma\u2010related and clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 87 skeletally immature patients with ACL injuries and a minimum follow\u2010up of 1 year were included and matched based on sex and skeletal age with 44 controls. The presence of the DLFNS, defined as a notch depth of &gt;1.5\u2009mm, was assessed on MRI. Intra\u2010 and inter\u2010observer reliability were calculated, and prevalence was determined. Associations between the DLFNS and trauma mechanism, trauma\u2010related bone lesions, concomitant injuries, clinical instability, and treatment at both baseline and follow\u2010up were assessed using Fisher's exact tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of DLFNS was 11.5% (10\/87) among skeletally immature patients with ACL injuries compared to 0% (0\/44) in controls (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). DLFNS depth demonstrated excellent intra\u2010 and inter\u2010observer reliability (ICC\u2009&gt;\u20090.90). Furthermore, a significant positive association was identified between the DLFNS and overall concomitant knee injuries (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), including ligamentous, meniscus, and cartilage injuries. Further subgroup analysis did not reveal any statistically significant associations with individual injury types. All patients presenting with a DLFNS ultimately received operative treatment, either during initial management or follow\u2010up. This revealed a significant positive association between the DLFNS and primary operative treatment (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of the DLFNS in skeletally immature patients with ACL injuries was 11.5%. When present, the DLFNS was associated with overall concomitant knee injuries and primary ACL reconstruction. The DLFNS may therefore be an important sign to take into consideration on the primary MRI in skeletally immature patients with ACL injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70595","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T03:25:08Z","timestamp":1766978708000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The deep lateral femoral notch sign (DLFNS) is associated with concomitant knee injuries in skeletally immature patients with anterior cruciate ligament injuries"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1569-6850","authenticated-orcid":false,"given":"Annika Babette","family":"Ito","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery &amp; Trauma M\u00e1xima Medical Centre Eindhoven\u2010Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Christine van der","family":"Steen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery &amp; Trauma M\u00e1xima Medical Centre Eindhoven\u2010Veldhoven the Netherlands"},{"name":"Department of Orthopaedic Surgery &amp; Trauma Catharina Hospital Eindhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin Nicolaas Julian","family":"Voskuilen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery &amp; Trauma M\u00e1xima Medical Centre Eindhoven\u2010Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob Paulus Augustinus","family":"Janssen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery &amp; Trauma M\u00e1xima Medical Centre Eindhoven\u2010Veldhoven the Netherlands"},{"name":"Department of Biomedical Engineering Eindhoven University of Technology, Orthopaedic Biomechanics Eindhoven the Netherlands"},{"name":"Department of Paramedical Sciences Fontys University of Applied Science Eindhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn","family":"Dietvorst","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery &amp; Trauma M\u00e1xima Medical Centre Eindhoven\u2010Veldhoven the 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