Can a tibial tunnel in ACL surgery be placed anatomically without impinging on the femoral notch? A risk factor analysis

Bracht, Hans Van Der; Bellemans, Johan; Victor, Jan; Verhelst, Luk; Page, Benedict J.; Verdonk, Peter

doi:10.1007/s00167-013-2393-3

Cited by 14 publications

(13 citation statements)

References 25 publications

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“…Complete footprint restoration could result in a graft that is too large at its midsubstance to fit within the intercondylar notch, potentially causing pathological impingement. 20,21,28 The isthmus of the ACL, or the region of the smallest midsubstance cross-sectional area (CSA), is naturally and appropriately sized to fit within the intercondylar notch. The dimensions of the isthmus region may provide a more suitable template for graft sizes than the larger bony insertion sites.…”

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confidence: 99%

Quantitative In Situ Analysis of the Anterior Cruciate Ligament

et al. 2015

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confidence: 99%

Quantitative In Situ Analysis of the Anterior Cruciate Ligament

et al. 2015

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“… 7 , 17 , 23 , 25 , 26 It has been mostly utilized in the transtibial/isometric ACL reconstruction techniques, but many surgeons still perform notchplasty in the transportal/anatomic techniques. 12 , 15 , 18 , 25 , 28 …”

Section: Discussionmentioning

confidence: 99%

“…It has been utilized as an adjuvant procedure mostly in the transtibial/isometric ACL reconstruction techniques, but many surgeons still perform notchplasty in the transportal/anatomic techniques. 12 , 15 , 18 , 25 , 28 Other advantages of notchplasty include better visualization within the notch as well as an increase of the cross-sectional area of the regenerated ACL, providing more space for graft healing and enhancing the healing process. 14 , 15 , 19 However, there are concerns related to postoperative blood loss in the early phase, to knee biomechanics distortion, and even more to bone regrowth and narrowing of the notch after notchplasty, although these aspects are still debated.…”

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Does Bone Regrow After Notchplasty in ACL Reconstruction? A Prospective Computed Tomography Study With 2-Year Follow-up

Kitridis

Tsifountoudis

Georgiannos

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: During notchplasty in anterior cruciate ligament (ACL) reconstruction, bone is excised from the lateral and roof area of the notch to widen the intercondylar space and avoid notch-graft impingement in extension. There are concerns that bone regrowth of the area will cause narrowing and increase the risk of complications. Purpose: To determine the possibility of late narrowing of the notch after notchplasty using computed tomography (CT) analysis. Study Design: Case series; Level of evidence, 4. Methods: Measurements were performed on CT scans (axial and sagittal planes with knee in extension) in patients who had undergone single-bundle anatomic ACL reconstruction using hamstring graft. Two axial image levels were used: at the anterior outlet and the anterior one-eighth level of the notch. The maximum notch height and width, the notch width at one-third and two-thirds of the preoperative notch midwidth height, the maximum condylar width, and the surface area of the lateral half of the notch were measured preoperatively and at 1 week and 2 years postoperatively. Results: Included were 20 consecutive patients (mean ± standard deviation age, 28 ± 7.3 years; follow-up, 24.2 ± 3.3 months). At the anterior notch outlet, the maximum notch width increased by 1.9 ± 1.7 mm at 1 week postoperatively and narrowed by 0.3 ± 1.1 mm at the final follow-up, while the maximum notch height increased by 1.7 ± 1.9 mm and narrowed by 0.8 ± 1.8 mm, respectively. At one-eighth of the roof length, the maximum notch width increased by 1.1 ± 1.7 mm at 1 week postoperatively and narrowed by 0.1 ± 1.1 mm at the final follow-up, and the maximum notch height increased by 1.2 ± 1.5 mm and narrowed by 0.5 ± 1.5 mm, respectively. All differences were statistically significant when comparing the pre- to the immediate postoperative measurements, and they were nonsignificant when comparing the immediate postoperative to the final follow-up measurements. The same applied for the ratio of maximum notch width to maximum condylar width, indicating no postoperative narrowing of the notch. Conclusion: Notch size-shape after a 2-mm notchplasty did not change significantly in stable knees during the first 2 years after anatomic ACL reconstruction. Surgeons should consider performing this adjuvant technique when there is notch-graft impingement during surgery.

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“…Some useful suggestions have been provided to avoid notchplasty while performing ACLR, such as: respecting the graft free zone in the tibial footprint; 32 placing the tibial bone tunnel for the anteromedial bundle as medially as possible within its footprint to avoid wall impingement in double-bundle technique; 33 avoiding double-bundle technique in cases of narrow notch (<12 mm); 34 if a good view of the footprint is difficult to achieve, consider using an additional portal (three-portals technique); 35 in transtibial technique, if impingement is unavoidable or if it is present after graft fixation, remove bone as less as possible from the intercondylar notch; 7 8 36 avoid performing notchplasty in anatomical techniques; 4 32 35 choose the right size of the graft to avoid notch/graft mismatch and to decrease the incidence of cyclops lesions. 24 …”

Section: Discussionmentioning

confidence: 99%

Effects of Notchplasty on Anterior Cruciate Ligament Reconstruction: A Systematic Review

Ranuccio

Familiari

Tedesco

et al. 2017

Joints

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Purpose Notchplasty is a complementary surgical procedure often performed during anterior cruciate ligament reconstruction (ACLR) with the aim to widen the intercondylar notch and to avoid graft impingement. The aim of this review was to analyze the current literature evidence concerning the effects of notchplasty on clinical outcome after primary ACLR. Methods Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE were used to search English language studies, from January 1990 to July 2015, concerning the effects of the notchplasty on ACLR, using the following keywords: “ACL” OR “anterior cruciate ligament” OR “ACL reconstruction” OR “anterior cruciate ligament reconstruction” AND “notch” OR “notchplasty” OR “intercondylar notch”. Randomized and nonrandomized trials, case series, technical notes, biomechanical studies and radiological study were included. Results At the final screening 16 studies were included. Despite widely used, the usefulness of notchplasty during ACLR remains unclear. Some concerns emerged regarding potential harmful effects of notchplasty, mostly related to the knee biomechanics and postoperative blood loss. Notchplasty can be useful in the treatment of arthrofibrosis and in presence of bony spurs of the notch both in primary and revision surgery. However, the level of evidence of available literature is poor and there is a strong need for randomized controlled trials investigating the role of notchplasty on ACLR. Conclusion We suggest being aware of potential complications following notchplasty during ACLR before deciding to perform notchplasty in primary ACLR, reserving it for the surgical management of arthrofibrosis, treatment of notch osteophytosis and revision ACLR. Level of Evidence Level IV, systematic review of level II-IV studies.

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Can a tibial tunnel in ACL surgery be placed anatomically without impinging on the femoral notch? A risk factor analysis

Cited by 14 publications

References 25 publications

Quantitative In Situ Analysis of the Anterior Cruciate Ligament

Quantitative In Situ Analysis of the Anterior Cruciate Ligament

Does Bone Regrow After Notchplasty in ACL Reconstruction? A Prospective Computed Tomography Study With 2-Year Follow-up

Effects of Notchplasty on Anterior Cruciate Ligament Reconstruction: A Systematic Review

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