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Objectives <p>The notch of Harty (NOH) is a pseudolesion located at the distal tibial plafond that can mimic a clinically significant osteochondral lesion. Reported prevalence in an adult population ranged between 25% and 45%, but the prevalence in younger age groups is unknown. In this study, we assessed the age-dependent prevalence of the NOH in a young population to investigate potential remodeling over time.</p> Materials and methods <p>A retrospective analysis of a single-center database included 895 ankle MRIs of patients aged 6–25 years between 2018 and 2022. Cases with significant artifacts or pathological conditions were excluded. The NOH was categorized into types 1 (fluid-filled) and 2 (cartilage-filled), and measurements were taken for mediolateral, craniocaudal, and anteroposterior dimensions. Logistic and linear regression models with restricted cubic splines assessed age-related trends. Radiographic sensitivity for NOH detection was evaluated in 252 radiographs with MRI-confirmed NOH as a secondary endpoint.</p> Results <p>The overall prevalence of NOH in this study population was 47.1% (14.9% type 1 and 31.6% type 2). Type 1 prevalence peaked at age 8 and declined into adulthood, while type 2 prevalence peaked at age 14 and stabilized through adolescence. The NOH size increased with age until 16 years and subsequently decreased. Radiographic sensitivity for detecting NOH was 51.2%.</p> Conclusion <p>The NOH is more common in younger individuals, with prevalence and size decreasing with age. This supports its classification as a developmental variant characterized by age-related remodeling.</p> Critical relevance statement <p>This study provides novel insights into the age-dependent prevalence and remodeling of the NOH, enhancing diagnostic precision and improving differentiation between developmental variants and pathological findings in clinical radiology.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>The study investigates the age-dependent prevalence of the NOH.</p> </ItemContent> <ItemContent> <p>Results show developmental remodeling patterns with prevalence peaking in younger individuals.</p> </ItemContent> <ItemContent> <p>Data support the theory of NOH being a developmental variant.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>

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Age-dependent prevalence of the Notch of Harty (pseudolesion of the tibial plafond) in children, adolescents, and young adults

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月9日

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  • Pauline Maria Hiller,
  • Maximilian Schmalfuss,
  • Lara Diedrichsen,
  • Tobias Johannes Dietrich,
  • Simon Wildermuth,
  • Stephan Waelti,
  • Anna Falkowski,
  • Nicole Graf,
  • Tim Steffen Fischer

摘要

Objectives

The notch of Harty (NOH) is a pseudolesion located at the distal tibial plafond that can mimic a clinically significant osteochondral lesion. Reported prevalence in an adult population ranged between 25% and 45%, but the prevalence in younger age groups is unknown. In this study, we assessed the age-dependent prevalence of the NOH in a young population to investigate potential remodeling over time.

Materials and methods

A retrospective analysis of a single-center database included 895 ankle MRIs of patients aged 6–25 years between 2018 and 2022. Cases with significant artifacts or pathological conditions were excluded. The NOH was categorized into types 1 (fluid-filled) and 2 (cartilage-filled), and measurements were taken for mediolateral, craniocaudal, and anteroposterior dimensions. Logistic and linear regression models with restricted cubic splines assessed age-related trends. Radiographic sensitivity for NOH detection was evaluated in 252 radiographs with MRI-confirmed NOH as a secondary endpoint.

Results

The overall prevalence of NOH in this study population was 47.1% (14.9% type 1 and 31.6% type 2). Type 1 prevalence peaked at age 8 and declined into adulthood, while type 2 prevalence peaked at age 14 and stabilized through adolescence. The NOH size increased with age until 16 years and subsequently decreased. Radiographic sensitivity for detecting NOH was 51.2%.

Conclusion

The NOH is more common in younger individuals, with prevalence and size decreasing with age. This supports its classification as a developmental variant characterized by age-related remodeling.

Critical relevance statement

This study provides novel insights into the age-dependent prevalence and remodeling of the NOH, enhancing diagnostic precision and improving differentiation between developmental variants and pathological findings in clinical radiology.

Key Points

The study investigates the age-dependent prevalence of the NOH.

Results show developmental remodeling patterns with prevalence peaking in younger individuals.

Data support the theory of NOH being a developmental variant.

Graphical Abstract