Stenotic Intercondylar Notch as a Risk Factor for Physeal-Sparing ACL Reconstruction Failure: A Case-Control Study

Abstract

Introduction: Identifying risk factors is crucial for developing strategies that minimize reinjury after anterior cruciate ligament reconstruction (ACLR). This study aims to determine whether certain features of intercondylar notch geometry are associated with failure of physeal-sparing ACLRs in skeletally immature athletes. Methods: Nine failed physeal-sparing ACLRs were compared with a control subject group of 15 age- and sex-matched intact physeal-sparing ACLRs. Notch width index (NWI), notch angle (NA), and intercondylar notch roof inclination angle (RA) were measured on preoperative MRIs. Results: Median NWI was smaller in the failed ACLR versus control subject group in coronal (0.23 versus 0.27; P < 0.05) and axial planes (0.25 versus 0.27; P = 0.055). Median NA was smaller in the failed ACLR versus control subject group in coronal (49.6 versus 61.0°; P < 0.05) and axial planes (48.6° versus 54.9°; P < 0.05). Median RA was steeper in the failed ACLR versus control subject group (132.0° versus 125.7°; P < 0.05). Conclusion: NWI, NA, and RA were associated with ACLR failure in skeletally immature patients undergoing physeal-sparing reconstruction. A smaller, narrower, and steeper notch may predispose these patients to reinjury.

Hereditary Anatomical Risk Factors for Anterior Cruciate Ligament Injuries

“…Intercondylar roof inclination angle (RA) is the obtuse angle formed by the intersection of a line over the Blumensaat line and a line parallel to the long axis of the knee in the midsagittal view. MWI, NA, and RA measurements are as described by Tuca et al [18].…”

“…A stenotic intercondylar notch can lead to impingement of the ACL on the lateral femoral condyle, exposing it to anterior shear force or tibial rotation, potentially resulting in rupture [11]. Several studies have highlighted the significance of a narrow intercondylar notch and a steep tibial slope as risk factors for ACL injury [12][13][14][15][16][17][18][19][20]. However, it's noteworthy that some studies have failed to establish a significant correlation between a narrow intercondylar notch and the risk of ACL tear [21,22].…”

The intercondylar fossa—A narrative review

“…Notch stenosis is the main osseous cause for ACL injury. This is relevant not only to the initial development of ACL injury, but also to rerupturing of the reconstructed graft and degenerative changes to it (Ahn et al, 2007 ; Fujii et al, 2015 ; Herbst et al, 2017 ; Mayr et al, 2017 ; Muellner et al, 1999 ; Tuca et al, 2021 ). However, there is currently no overall agreement about a cut‐off value for IN measurements.…”

“…In ACL reconstruction, some authors therefore suggest performing a notchplasty in combination with reconstruction of the ligament itself in order to minimize the rerupture and failure rates and the postoperative development of a so‐called cyclops formation (Ahn et al, 2007 ; Asahina et al, 2000 ; Dienst et al, 2007 ; Fujii et al, 2015 ; Herbst et al, 2017 ; Iriuchishima et al, 2013 ; Keklikci et al, 2013 ; Mayr et al, 2017 ; Muellner et al, 1999 ; Orsi et al, 2017 ; Tuca et al, 2021 ).…”

A Modified Lemaire Lateral Extra-articular Tenodesis in High-Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft: 2-Year Clinical Outcomes

“…14 Additional risk factors include participation in high-risk competitive sports (eg, football, soccer, and basketball), generalized ligamentous laxity, knee hyperextension, stenotic intercondylar notch, chronic ACL laxity, and history of contralateral ACL injury. 28,32 A relative risk factor has been reported in 8th and 9th grade athletes as well. 4 The more modest clinical outcomes achieved with revision ACLR highlight the need to (1) identify individuals at increased risk of failed primary ACLR and (2) develop surgical strategies to mitigate the risk of ACL retear in these at-risk patients.…”