Notchplasty is associated with decreased risk of anterior cruciate ligament graft revision

Thompson, Rory; Hamilton, David F.; Murray, Iain; Lawson, Graham M.

doi:10.1007/s00590-022-03305-z

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…As it remains unclear where to place the ideal tibial tunnel, our findings indicate that this is not simply decided by considering whether the tibial tunnel is located anteriorly or posteriorly, but by considering the intercondylar notch anatomy in the ACLR. Placing the tibial tunnel in the posterior part of the tibial footprint or performing notchplasty helps avoid roof impingement, especially in the presence of a steep roof inclination angle and a narrow notch [25, 30, 35]. Thus, surgeons must focus on intercondylar notch anatomy during tibial tunnel placement.…”

Section: Discussionmentioning

confidence: 99%

Graft impingement increases anterior cruciate ligament graft signal more than acute graft bending angle: magnetic resonance imaging‐based study in outside‐in anterior cruciate ligament reconstruction

Park

Cho

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose In this study, the relationship between patient-speciic geometric factors and tunnel placement in graft impingement was identiied by using magnetic resonance imaging (MRI) signal intensity of anterior cruciate ligament (ACL) grafts. Methods Ninety-two patients, who were treated between 2014 and 2020, were included retrospectively. These patients underwent primary remnant-preserving outside-in ACL reconstruction (ACLR) and were followed up with postoperative MRI at least one year after surgery. Plain radiographs and computed tomography (CT) were used to analyze tibial and femoral tunnel positions. Postoperative MRI was performed, at 32.8 ± 17.5 months after surgery, to evaluate the graft signal intensity, the ACL/posterior cruciate ligament (PCL) ratio (APR), ACL/muscle ratio (AMR), tunnel positions, and graft impingement. Clinical and stability outcomes were analyzed using the International Knee Documentation Committee (IKDC) subjective and objective scores, Lysholm scores, and side-to-side diferences (SS-D). ResultsThe mean APR and AMR of the proximal third of the grafts were signiicantly lower than those of the middle third of the grafts (p = 0.017 and p = 0.045, respectively). Multivariate regression analysis showed that there was a negative association between the mean APR and AMR of entire intra-articular ACL graft and the distance from the anterior end of the intercondylar roof to the center of the tibial tunnel in the sagittal plane (p < 0.001 and p < 0.001, respectively) and the notch width index (p < 0.001 and p = 0.002, respectively). No signiicant correlations were found between tunneling and geometric factors, and clinical scores or SS-D. Conclusions Graft impingement on the anterior tibial tunnel relative to the end of the intercondylar roof and narrow notch was a more signiicant contributing factor on increased signal intensities of the ACL graft, compared with the acute femoral bending angle in remnant-preserving outside-in ACLR. Therefore, surgeons should focus on intercondylar notch anatomy during tibial tunnel placement to avoid roof impingement. Level of evidence Level III.

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Section: Discussionmentioning

confidence: 99%

Graft impingement increases anterior cruciate ligament graft signal more than acute graft bending angle: magnetic resonance imaging‐based study in outside‐in anterior cruciate ligament reconstruction

Park

Cho

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…2 ). In the most severe cases especially in revision cases with big osteophytes in the notch, a notchplasty during ACL-R should be considered ( 56 , 57 ); albeit there is chance of bony regrowth. Besides the notch size, the relationship between other bony morphologic characteristics such as size of the femoral condyles and the ratio between medial and lateral femoral condyle size may also influence the risk of ACL injury risk and graft failure.…”

Section: Reasons Of Failurementioning

confidence: 99%

ACL surgery: reasons for failure and management

et al. 2023

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Despite the general success of anterior cruciate ligament reconstructions (ACL-R), there are still studies reporting a high failure rate. Orthopedic surgeons are therefore increasingly confronted with the treatment of ACL retears, which are often accompanied by other lesions, such as meniscus tears and cartilage damage and which, if overlooked, can lead to poor postoperative clinical outcomes. The literature shows a wide variety of causes for ACL-R failure. Main causes are further trauma and possible technical errors during surgery, among which the position of the femoral tunnel is thought to be one of the most important. A successful postoperative outcome after ACL-revision surgery requires good preoperative planning, including a thorough evaluation of patient's medical history, e.g. instability during daily or sports activity, increased general joint laxity, and hints for a low-grade infection. A careful clinical examination should be performed. Additionally, comprehensive imaging is necessary. Besides a magnetic resonance imaging, a CT scan is helpful to determine location of tunnel apertures and to analyze for tunnel enlargement. A lateral knee radiograph is helpful to determine the tibial slope. The range of surgical options for the treatment of ACL-R failure is broad today. Orthopedic surgeons and experts in Sports Medicine must deal with various possible associated injuries of the knee or unfavorable anatomical conditions for ACL-R. The aim of this review was to highlight predictors and reasons of failures of ACL-R as well as describe diagnostic procedures to individualize treatment strategies for improved outcome after revision ACL-R.

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“…33 Although notchplasty has been associated with a decreased risk of graft revision, roof impingement may recur following adequate notchplasty, attributed to fibrocartilaginous overgrowth at the operative site. 33,34 On MRI, this appears as a variably present irregular layer of intermediate signal intensity along the intercondylar notch, following the signal characteristic of hyaline cartilage. 33 Following ACL injury, accelerated osteoarthritis is one of the important long-term considerations for all patients.…”

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confidence: 99%

Postoperative Return to Play and the Role of Imaging

Brumbaugh,

Casagranda

2024

Semin Musculoskelet Radiol

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Return to play (RTP) following surgery is a complex subject at the interface of social and internal pressures experienced by the athlete, psychological readiness, and intrinsic healing of the surgically repaired structures. Although functional testing, time from surgery, clinical examination, and scoring metrics can help clarify an athlete's readiness to return to sport, imaging can allow for a more direct assessment of the structures in question. Because imaging is often included in the diagnostic work-up of pain following surgery, the radiologist must be familiar with the expected postsurgical imaging appearance, as well as the associated complications. We briefly review such findings following anterior cruciate ligament reconstruction, Achilles tendon repair, syndesmotic fixation, and ulnar collateral ligament reconstruction in the context of the athlete, highlighting issues related to RTP.

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Notchplasty is associated with decreased risk of anterior cruciate ligament graft revision

Cited by 5 publications

References 28 publications

Graft impingement increases anterior cruciate ligament graft signal more than acute graft bending angle: magnetic resonance imaging‐based study in outside‐in anterior cruciate ligament reconstruction

Graft impingement increases anterior cruciate ligament graft signal more than acute graft bending angle: magnetic resonance imaging‐based study in outside‐in anterior cruciate ligament reconstruction

ACL surgery: reasons for failure and management

Postoperative Return to Play and the Role of Imaging

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