ORIGINAL ARTICLE OPEN ACCESS

Normal Dimensions of Lateral Femoral Condyle

in Pakistani Population
Mohib Ullah Khan1, Hidayat Ullah2, Saeed Ahmad2, Zia Ullah3, Mehtab Ullah4, Zahid Askar5, Malik Javed Iqbal5,
1
Orthopedic Surgeon Department, DHQ Hospital Miranshah, North Waziristan Tribal District, Pakistan, 2Orthopaedics
Department, Peshawar Medical College, Peshawar, Pakistan, 3Orthopaedics, Khalifa Gul Nawaz Hospital, Bannu,
Pakistan, 4Arthroscopy and Sports Surgery, Medical Teaching Institute, Hayatabad Medical Complex, Peshawar, Pakistan,
5
Orthopedic Department, Peshawar General Hospital, Peshawar, Pakistan.

ABSTRACT

Background: The medial condyle is wider and having larger surface area for articulation than lateral
femoral condyle however anteroposteriorly lateral femoral condyle is larger. The aim of this study
was to find normal dimensions of lateral femoral condyle in Pakistani population.

Methods: This Cross-sectional descriptive study, carried out from September 2023 to May 2024 in
Radiology department of Peshawar General Hospital, Peshawar with sample size of 385. Non
probability convenience sampling technique was used. All healthy adult, intact femur with clear
features were included and scanned through magnetic resonance imaging. Data analysis was
done through SPSS version 22, descriptive analysis was done and association was assessed by
applying independent sample t-test and ANOVA. P-value < 0.5 was considered statistically
significant.

Results: About 54% (n=149) male participants and 60% (n=67) of females had right knee
measurements, whereas 46% (n=125) males and 40% (n=44) females had measurements of their left
knee. There was no significant relationship between gender and the measured side (p=0.169). Age
and size of the lateral femoral condyle were shown to be significantly correlated (p=0.027). Males
exhibited greater femoral condyle dimensions, notch widths, and heights compared to females
(p<0.001). Furthermore, ANOVA showed statistically significant variations in parameters of lateral
femoral condyle, notch width, and height with age (p<0.001).

Conclusion: This study demonstrates that the femoral condyles parameters depend on several
variables and differ by gender and region. Considering this study, accurate tunnel in lateral femoral
condyle can be made for anterior cruciate ligament graft in ACL injury.

Keywords: Femoral Condyles, Lateral Femoral Condyle Dimensions, Magnetic Resonance Imaging.

Corresponding Author:
Dr. Mehtab Ullah
Fellow Arthroscopy and Sports Surgery,
Medical Teaching Institute, Hayatabad Medical Complex, Peshawar, Pakistan.
Email: [email protected]
Doi: https://doi.org/10.36283/ziun-pjmd13-4/019

How to cite: Khan MU, Ullah H, Ahmad S, Ullah Z,Ullah M,Askar Z,Iqbal MJ,Khan G Normal Dimensions
of Lateral Femoral Condyle in Pakistani Population. Pak J Med Dent. 2024;13(4): 148-155. Doi:
https://doi.org/10.36283/ziun-pjmd13-4/019.

Received: Sat, August 17, 2024 Accepted: Tue, Oct 01, 2024 Published: Thu, Oct 24, 2024

This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0
https://creativecommons.org/licenses/by/4.0/

148 PAKISTAN JOURNAL OF MEDICINE AND DENTISTRY 2024, VOL. 13 (04) DOI: https://doi.org/10.36283/PJMD13-4/019
INTRODUCTION healthcare, archaeological research, prosthetics,
The largest, intricate, and most dislocated joint in the sports surgery, and biomedical engineering can all
whole human body is the knee joint. Knee mechan- benefit greatly from these measurements. Numer-
ics are greatly affected by the intricate multidimen- ous radiologic research studies have been carried
sional 3-D configuration of the distal lateral and out to measure different parameters of distal femo-
medial femoral condyles 1. The knee is vulnerable to ral condyles in humans14,15. The most accurate
intense forces, long-term conditions, and collisions method for assessing femoral condyles is magnetic
since it is in between the two bones, that is femur resonance imaging16. To make a tunnel in the lateral
and tibia which carries the whole weight of the femoral condyle in anterior cruciate ligament injury,
upper body2. Although males are more involved in the current study aim was to find the width/ dimen-
sports activity and strenuous physical work the sions of the lateral femoral condyle so that the
incidence of injuries and chronic diseases to the length of the femoral tunnel is determined.
knee joint is higher in females than the male3. Men's
and women's knees are anatomically different from METHODS
each other reported by several studies4,5. Some This was a cross-sectional descriptive study that
studies reported that the anterior femoral condyle lasted for 9 months, starting in September 2023 and
height in males is slightly higher than that of females ending on May 30th, at Radiology department,
which results in the formation of knee implants Peshawar General Hospital, Peshawar. Non-proba-
having thinner and narrower anterior flange for bility convenient sampling technique was used. The
females6. sample size was initially calculated to be 211through
OpenEpi, based on a population of 2,481,000 from
The distal end of the femur is formed by two Peshawar, with a confidence level of 95%, a margin
condyles that articulate with the tibial bone to form of error of 3%, and an anticipated frequency of ACL
a knee joint; they are covered by articular carti- injuries in male about 5.2%.17 However, to ensure
lage7-9. The medial condyle is wider and has a larger greater accuracy and reliability of the results, a total
surface area for articulation than the lateral femoral of 385 participants were included in the study. All
condyle however, Antero-posteriorly lateral femoral healthy and intact femur with clear features adults
condyle is larger. They are cam-shaped when were included in the study whereas patients with
imaged from the lateral view10. These condyles meet fractured bones, congenital bone/joint disorders,
at the anterior surface but are separated from each and incomplete bones were excluded from the
other posteriorly by a deep fossa called intercondy- study.
lar fossa and extend past the popliteal surface
plane11 .The medial surface of the LFC and MFC Consent form from participants was taken and
forms the lateral and medial wall of the fossa ethical approval was also taken from the ethical
respectively. One can plainly palpate the bulge committee (Ref No. 1010, on dated 15/08/2023).
and prominent convex medial aspect of the medial Anthropometric data was recorded on the ques-
condyle12,13. Differences in ethnicity, age, sex, habits, tionnaire after completion of scan and measuring
ways of life, environmental conditions, and diet, the various parameters on radiographic images.
affect anthropometric measurements of the femur,
which vary from place to place. The fields of forensic

Figure 1: Anteroposterior dimension of Medical Figure 2: Anteroposterior dimension of Medical

and Lateral femoral condyle (6.37cm and and Lateral femoral condyle (7.07cm and
6.26cm respectively), intercondylar distance 7.31cm respectively), intercondylar width
(7.13cm), and Femoral Notch width (2.26cm) (8.25cm), and Femoral Notch width (2.23cm)

PAKISTAN JOURNAL OF MEDICINE AND DENTISTRY 2024, VOL. 13 (04) DOI: https://doi.org/10.36283/PJMD13-4/019 149
 Normal Dimensions of Lateral Femoral Condyle in Pakistani Population

Figure 3: Anteroposterior dimension of Medical Figure 4: Anteroposterior dimension of Medical

and Lateral femoral condyle (6.74cm and and Lateral femoral condyle (7.13cm and
6.22cm respectively), intercondylar distance 6.95cm respectively), intercondylar width
(8.64cm), and Femoral Notch width (2.49cm) (8.73cm), and Femoral Notch width (2.33cm

A 1.3T magnetic resonance imaging (MRI) machine ent parameters of the participants such as age,
was quality assured prior this study. All the subjects dimension of lateral femoral condyle, width and
were scanned through MRI with knee joint protocol. height of the notch. All results were summarized in
During scanning the foot of the individual was tabular and graphical form. Moreover, independent
placed in special footgear in order to avoid mobility t-tests and ANOVA were used to find out the differ-
of the limb and standardize the position for lower ences among groups. P-value < 0.5 was considered
limb procedure. There was no contrast media statistically significant.
administration in this scanning procedure. T1 weight-
ed, T2 weighted and proton density images were RESULTS
taken in axial, coronal and sagittal planes with thin Within the male participants, the data indicates that
slices and slice gap. Additional reconstruction from 149 (54.3%) individuals had measures taken on their
raw data in 3-D plane was also performed. The ante- right knee joint, whereas 125 (45.7%) individuals had
ro-posterior (AP) measurements of the femoral measurements done on their left knee joint. Among
condyles, medial condyle dimensions, lateral the female participants, 67 (60.3%) included mea-
condyle dimensions, trans-epicondylar axis, notch sures of their right knee, whereas 44 (39.7%) included
width and notch height were measured through measurements of their left knee. The obtained p-val-
caliper and measurement tool. ue of 0.169 indicates no significant correlation
between gender and the side of the knee joint. The
Data analysis was done through SPSS version 22, age group distribution exhibits a mostly uniform
descriptive statistical analysis and independent spread, with a little decline in the participation
sample t-test for association lateral femoral condyle, count among older age groups. No significant
width and height of notch with gender of the partici- correlation between age and the presence of the
pants. Chi-square test was used to assess relation of right or left knee joint in this cohort (p=0.973) (Table
the side of knee with gender and different age 1).
groups. Bivariate analysis for the correlation of differ-

Table 1: Association of Gender and Age with The Side of The Knee Joint

Variable Detail Side of Knee Joint P value

Right Left

Gender Male 149 (54.3%) 125 (45.7%) 0.169

Female 67 (60.3%) 44 (39.7%)

150 PAKISTAN JOURNAL OF MEDICINE AND DENTISTRY 2024, VOL. 13 (04) DOI: https://doi.org/10.36283/PJMD13-4/019
 Age of the 20-25 Years 6 (54.5%) 5 (45.5%) 0.973
participants
26-30 Years 67 (58.7%) 47 (41.3%)

31-35 Years 59 (57.2%) 44 (42.8%)

36-40 Years 39 (54%) 32 (46%)

41-45 Years 30 (53.5%) 26 (46.5%)

46-50 Years 13 (52%) 12 (48%)

> 50 Years 2 (40%) 3 (60%)

Cross-tabulation and Chi-square test

The highest number of participants were noted in age group 26-30 years while least in age group
>50 years. The mean value of dimension of lateral femoral condyle in age group 20-25 was
2.87cm with standard deviation of 0.29cm, mean value in age group 26-30 was 3.15 ± 0.36cm,
mean value in age group 31-35 was 2.90 ± 0.18cm, in age group 36-40 was 2.80 ± 0.26cm, in age
group 41-45 was 2.99 ± 0.24cm, in age group 46-50 was 3.37 ± 0.05cm while in age group >50
was 3.35 ± 0.008cm noted (Table 2).

Table 2: Dimension of Lateral Femoral Condyle with Age Groups.

Age of the Subject N Minimum Maximum Mean±SD

20-25 Years 11 2.57 3.23 2.87±0.29

26-30 Years 114 2.28 3.54 3.16±0.36

31-35 Years 103 2.60 3.17 2.90±0.18

36-40 Years 71 2.46 3.20 2.80±0.26

41-45 Years 56 2.54 3.23 2.99±0.24

46-50 Years 25 3.10 3.40 3.37±0.06

>50 Years 5 3.35 3.37 3.35±0.01

Total 385 2.28 3.54 3.01±0.31

A statistically significant association (p-value of 0.027) between the participant's age and the
dimension of the lateral femoral condyle. Nevertheless, the relationship between age and other
factors, such as the breadth and height of the notch, lacks statistical significance, as shown by p-
values of 0.150 and 0.265, respectively. A statistically significant negative correlation (r=-0.272,
p=0.0001) exists between the lateral femoral condyle's dimension and the notch's height. No
significant link between the width of the notch and the side of the knee joint, as shown by p-values
of 0.493 and 0.928, respectively. Notably, there is a significant positive relationship between the
width and height of the notch (r=0.544, p=0.0001), indicating that as the breadth of the notch
grows, its height also rises. Furthermore, the association between the width of the notch and the
side of the knee joint is also statistically significant (r=0.105, p=0.039), while the intensity of the link
is somewhat weak. No statistically significant relationship between the side of the knee joint and
the height of the notch (p=0.568) (Table 3).

PAKISTAN JOURNAL OF MEDICINE AND DENTISTRY 2024, VOL. 13 (04) DOI: https://doi.org/10.36283/PJMD13-4/019 151
 Normal Dimensions of Lateral Femoral Condyle in Pakistani Population

Table 3: Bivariate Analysis for the Correlation of Different Parameters of the Participants.

Parameters Age of the Dimension of Width of Notch Height of Notch

subject lateral Femoral
condyle

Age of the 1 r = 0.603 r = 0.150 r = 0.265

subject
P-value= 0.027 P-value= 0.003 P-value <0.001

Dimension of 1 r = -0.035 r = -0.272

lateral femoral
condyle P-value= 0.493 P-value <0.001

Width of Notch 1 r = 0.544

P-value <0.001

Height of Notch 1

Pearson correlation

The mean value for the dimension of the lateral femoral condyle among male participants was
3.0586±0.31 cm. By contrast, the female participants had a much lower average value of
2.8932±0.27 cm. These findings indicate that males generally have a greater horizontal dimension
of the lateral femoral condyle than females (p-value <0.001). A comparison of notch width
revealed that men had an average width of 2.3482, with a standard deviation of 0.35905. In
contrast, girls had an average width of 2.1714, with a standard deviation of 0.27218. The
measurements suggest that males often have a broader notch than females (p-value <0.001).
Concerning the notch height, the average height of male participants was 2.6656, with a
standard deviation of 0.39302. The mean height of female participants was somewhat lower at
2.5566, with a standard deviation of 0.25733. These results indicate that men generally have a
higher notch height than females having p-value = 0.002 (Table 4).

Table 4: Comparison of Gender with Dimension of lateral femoral condyle, Width and Height of
Notch

Variable Gender N Mean ± SD P-value

Dimension of the lateral femoral condyle (cm) Male 274 3.0586±0.31

Female 111 2.8932±0.27 <0.001

Width of notch (cm) Male 274 2.3482±0.35

Female 111 2.1714±0.27 <0.001

Height of notch (cm) Male 274 2.6656±0.39

Female 111 2.5566±0.25 0.002

Independent Sample T-test

The independent t-test was used to assess the difference in dimension of lateral femoral condyle,
width and height of notch between the right and left sides of the knee joint. For the dimension of
the lateral femoral condyle, the right side had a mean of 3.0044 cm and a standard deviation of
0.31891, while the left side had a mean of 3.0191 cm, and a standard deviation of 0.31413 with a
p=0.651, indicating no significant difference between both sides. Regarding the width of the

152 PAKISTAN JOURNAL OF MEDICINE AND DENTISTRY 2024, VOL. 13 (04) DOI: https://doi.org/10.36283/PJMD13-4/019
notch, the right side had a mean of 2.2677 (SD = 0.33693), compared to the left side, which had
a mean of 2.3246 (SD = 0.35651). For the height of the notch, the right side showed a mean of
2.6238 (SD = 0.36048), while the left side had a mean of 2.6270 (SD = 0.36157), for the width of the
notch, the p-value was 0.109, which also suggests no significant difference; and for the height of
the notch, the p-value was 0.932, indicating a lack of significant difference between the two sides
(Table 5).

Table 5: Comparison of Side with Dimension of lateral femoral condyle, Width and Height of
Notch
Variable Side N Mean ± SD P-value
Dimension of the lateral femoral condyle (cm) Right 212 3.0044cm±0.318 0.651

Left 173 3.0191cm±0.314

Width of notch (cm) Right 212 2.2677cm±0.336 0.109

Left 173 2.3246cm±0.356

Height of notch (cm) Right 212 2.6238cm±0.360 0.932

Left 173 2.6270cm±0.361

Independent Sample T-test

DISCUSSION lation, as there is an association between lateral

The distal femur's dimensions and form play a signifi- condyle dimension and gender.
cant role when determining the knee mechanics.
Distal femur characteristics have a significant CONCLUSION
impact on a number of diseases, including OA and This study demonstrates that the femoral condyles
patellofemoral pathologies18. Racial, gender, and parameters depend on several variables and differ
regional differences exist in the distal femur's dimen- by gender and region. Considering this study, an
sions19. The mean lateral femoral condyle dimension accurate tunnel in the lateral femoral condyle can
in this study for males is 3.05 ± 0.31 cm, while for be made for anterior cruciate ligament graft in ACL
females it is 2.89 ± 0.27 cm. These values are compa- injury. Sports health professionals and orthopedic
rable to data from a study conducted in Turkey, with surgeons should take this into account when plan-
a mean value of 2.44±2.58 cm, and another study in ning implants and performing procedures. Accurate
Ohio, reporting a mean value of 2.42±3 cm.18-20 The and appropriate size implants will reduce the risk of
average lateral condyle thickness measured was implant loosening and the patient will feel comfort-
2.53 ± 3.15 cm, which was slightly greater than the able. Forensic specialists in common practice will
values reported for Caucasian individuals, with 2.36 also benefit from the data collected here.
± 2.18 cm and 2.48 ± 3 cm from studies conducted in
Turkey and Ohio, respectively19,18. DECLARATIONS
This study was conducted to analyze and compare
The mean notch width in this study is 2.29 ± 0.34 cm, anatomical dimensions of the lateral femoral
which is slightly higher than the 2.05 ± 2.2 cm report- condyle and notch width in the study population,
ed in a study from Greece, but lower than the mean highlighting differences across gender and compar-
value found in Kenya21,22. The mean notch height in ing the results with previous studies conducted in
our study is 2.63 ± 0.36 cm, which is slightly higher different regions.
than the values reported in Greece and Turkey, as
indicated by previous studies23,24. ACKNOWLEDGMENTS
We would like to acknowledge all patient’s contri-
The limitation of this study is that we assessed only a bution in this study.
few parameters of the lateral femoral condyle such
as lateral femoral condyle dimension, notch height, CONFLICT OF INTEREST
and notch width. We recommend orthopedic The authors have no conflict of interest.
surgeons, implants, and prosthesis designers take
help from the data of this study for designing accu- ETHICAL APPROVAL
rate implants and prostheses for the Pakistani popu- The permission was obtained from the Institutional

PAKISTAN JOURNAL OF MEDICINE AND DENTISTRY 2024, VOL. 13 (04) DOI: https://doi.org/10.36283/PJMD13-4/019 153
 Normal Dimensions of Lateral Femoral Condyle in Pakistani Population

Review Board/Ethics Committee of the Peshawar 2016;3(4):427. DOI: 10.5958/2394-2126.2016.00097.9

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interpretation. HU & GK: Did statistical analysis, final cance. Journal of Pharmaceutical Negative Results.
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