Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction

Background: Suspensory fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts has emerged as a popular device for femoral graft fixation. However, improper deployment of the suspensory fixation can compromise proper graft tensioning, leading to failure and revision. Also, soft tissue interposition between the button and bone has been associated with graft migration and pain, occasionally requiring revision surgery. Many surgeons rely on manual testing and application of distal tension to the graft to confirm proper button deployment on the lateral cortex of the femur for ACL graft fixation. Purpose: To determine the reliability of the manual resistance maneuver when applying distal tension to deploy the suspensory device along the lateral cortex of the femur. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing ACLR with a suture button suspensory device for femoral fixation were eligible for enrollment in the study. The surgeries were performed by 3 board-certified, sports medicine fellowship–trained orthopaedic surgeons at a single outpatient surgical center between May 2018 and June 2019. All grafts were passed in a retrograde manner into the femoral tunnel, and a vigorous manual tensioning maneuver in a distal direction was placed on the graft to deploy and secure along the lateral cortex of the femur. Intraoperative mini c-arm fluoroscopy was obtained to demonstrate proper suture button positioning. If interposing tissue or an improperly flipped button was identified, rectifying steps were undertaken and recorded. Results: A total of 51 patients with a mean age of 33.3 years were included in the study. Of these patients, 74.5% had normal suture button positioning identified via intraoperative fluoroscopic imaging, while 15.7% had interposed soft tissue and 9.8% had an improperly flipped button. In all cases, the surgeon was able to rectify the malpositioning intraoperatively. Conclusion: Despite the manual sensation of proper suspensory button positioning, intraoperative fluoroscopy identified suture button deployment errors in ACLR 25% of the time. Correcting the malpositioning is not technically demanding. These findings advocate for routine intraoperative surveillance to confirm appropriate suture button seating during ACLR.

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Combined Intra- and Extra-Articular Technique in Revision Anterior Cruciate Ligament Reconstruction

Joints ◽

10.1055/s-0037-1605590 ◽

2017 ◽

Vol 05 (03) ◽

pp. 156-163 ◽

Cited By ~ 4

Author(s):

Jessica Zanovello ◽

Federica Rosso ◽

Alessandro Bistolfi ◽

Roberto Rossi ◽

Filippo Castoldi

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Case Series ◽

Return To Sport ◽

Surgical Removal ◽

Level Of Evidence ◽

Anterior Cruciate ◽

Over The Top

Purpose The aim of the study was to evaluate the “over the top” (OTT) nonanatomical technique for revision of anterior cruciate ligament (ACL) reconstruction. Methods Twenty-four patients with a mean age of 31.9 ± 11.2 years underwent revision of ACL reconstruction using OTT technique. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner score, Subjective Patient Outcome for Return to Sport (SPORTS) score, Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, and KT-1000 evaluation were recorded at a mean follow-up of 30.7 ± 18.9 months. Results Postoperatively, the IKDC objective total score significantly improved (p = 0.0046). The KOOS, Lysholm, and Tegner scores also improved, but the results were not statistically significant (62.4 vs. 72.6, 6.5 vs. 75.8, and 4.1 vs. 6.0, respectively). The subjective IKDC evaluation score improved from an average of 51.1 points to 63.7 points at the last follow-up (p = 0.0027). The RTP prevalence was 81.8%, with 44.4% of the patients returning to the same preinjury level. According to the SPORTS score, 16.6% of patients played sport without limitations in activity and performance. The average ACL-RSI score was 52.1 ± 27.0. No major complications were reported. A total of 21.5% of patients underwent surgical removal of staples. The failure prevalence was 14.3% and the cumulative survivorship, calculated using the Kaplan–Meier method, was equal to 70% at 60 months of follow-up. Conclusion The OTT technique in the revision ACL reconstruction provided improvement in objective and subjective scores, good RTP prevalence, and acceptable rate of complication and failure. One of the advantages was the possibility to avoid the femoral tunnel. Level of Evidence Level IV, therapeutic case series.

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Use Caution When Assessing Preoperative Leg-Length Discrepancy in Pediatric Patients With Anterior Cruciate Ligament Injuries

The American Journal of Sports Medicine ◽

10.1177/0363546520952757 ◽

2020 ◽

Vol 48 (12) ◽

pp. 2948-2953

Author(s):

Madison R. Heath ◽

Alexandra H. Aitchison ◽

Lindsay M. Schlichte ◽

Christine Goodbody ◽

Frank A. Cordasco ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Intraclass Correlation ◽

Case Series ◽

Surgical Reconstruction ◽

Radiographic Examination ◽

Leg Length ◽

Level Of Evidence ◽

Anterior Cruciate

Background: Pre- and postoperative standing hip-to-ankle radiographs are critical for monitoring potential postoperative growth arrest and resultant deformities after pediatric anterior cruciate ligament (ACL) reconstruction. Purpose: To determine the prevalence of apparent preoperative leg-length discrepancies (LLDs) that resolve at the first postoperative radiographic examination in patients undergoing ACL reconstruction in order to understand what proportion of the noted preoperative deformities may have been inaccurate. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of prospectively collected preoperative and first postoperative full-length hip-to-ankle radiographs was performed in a cohort of skeletally immature patients who had an acute ACL injury and underwent subsequent surgical reconstruction. Leg length measurements for both the injured and the uninjured legs were obtained for comparison. Results: A total of 112 patients (mean age, 12.7 ± 1.7 years) were included (79 boys and 33 girls). Leg-length measurement interrater reliability among 3 raters for 25 randomly chosen images was nearly perfect (intraclass correlation coefficient, 0.996; 95% CI, 0.994-0.998). At baseline, there was no apparent preoperative LLD (<5 mm) in 48% (n = 54) of participants, while 37% (n = 41) displayed a small apparent LLD (5 to <10 mm), 12% (n = 13) displayed a moderate apparent LLD (10 to <15 mm), and 4% (n = 4) displayed a large apparent LLD (≥15 mm). Of the patients with an apparent preoperative LLD, 66% (n = 38) of them tore their ACL on the leg measuring shorter. At first postoperative radiographs, 48% (n = 28) of patients with an apparent preoperative LLD showed resolution to no LLD: 46% (n = 19) of patients with a small apparent preoperative LLD, 54% (n = 7) of patients with a moderate apparent LLD, and 50% (n = 2) of patients with a large apparent LLD. Conclusion: A high percentage of patients (48%) with apparent preoperative LLDs showed resolution to no LLDs by their first postoperative imaging, indicating that preoperative hip-to-ankle radiographs display some false LLDs in patients with recent ACL tears who are unable to fully extend their injured leg and bear weight.

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TECHNICAL VARIATION IN AFFIXING HAMSTRING GRAFTS TO THE TIBIA IN ACL RECONSTRUCTION

Acta Ortopédica Brasileira ◽

10.1590/1413-785220182602155160 ◽

2018 ◽

Vol 26 (2) ◽

pp. 94-97

Author(s):

MARCUS VINICIUS DANIELI ◽

JOÃO PAULO FERNANDES GUERREIRO ◽

ALEXANDRE OLIVEIRA QUEIROZ ◽

CARLOS ROBERTO PADOVANI

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Case Series ◽

International Knee Documentation Committee ◽

Interference Screw ◽

Anatomic Reconstruction ◽

Anatomic Acl Reconstruction ◽

Level Of Evidence ◽

Hamstring Grafts

ABSTRACT Purpose: To present a technical variation in tibial fixation of quadruple hamstring grafts during anatomic reconstruction of the anterior cruciate ligament (ACL). The secondary purpose was to decrease the costs associated with this procedure. Methods: Twenty patients who underwent ACL reconstruction were selected. A tibial tunnel was constructed using standard techniques, and a femoral tunnel was anatomically created using the outside-in technique. The hamstring autograft was passed (with its bend) into the tibial tunnel and affixed to the tibia using the suspensory technique and a simple staple. Femoral fixation was performed using a titanium interference screw. The patients underwent postoperative evaluations at 0, 3, 6 and 12 months using the subjective International Knee Documentation Committee (IKDC) form and Lysholm knee scores. Results: The IKDC and Lysholm score results improved over time (p<0.001) without major complications. The cost of the procedure could be reduced by using lower-cost hardware (staples). Conclusion: The proposed technique for anatomic ACL reconstruction using inverted hamstring grafts with their bend in the tibial tunnel, suspension-type fixation using a staple demonstrated good to excellent results after 1 year of follow up, with lower aggregate costs. Level of Evidence IV; Case series.

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CORRELATION BETWEEN ECCENTRIC TRAINING AND FUNCTIONAL TESTS IN SUBJECTS WITH RECONSTRUCTED ACL

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220182406184218 ◽

2018 ◽

Vol 24 (6) ◽

pp. 471-476

Author(s):

Heleodório Honorato Santos ◽

Catarina de Oliveira Sousa ◽

Christiane Lanatovitz Prado Medeiros ◽

José Angelo Barela ◽

Ana Maria Forti Barela ◽

...

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Control Level ◽

Case Series ◽

Peak Torque ◽

Knee Extension ◽

Triple P ◽

Eccentric Training ◽

Isokinetic Training ◽

Level Of Evidence

ABSTRACT Introduction: Eccentric training and jump tests are widely used to recover and measure deficits in knee strength and functionality after anterior cruciate ligament (ACL) reconstruction. Objective: To correlate knee extension and flexion torque generated by eccentric isokinetic training, with functional jump tests in subjects with reconstructed ACL. Method: Sixteen men with unilateral ACL reconstruction were assessed before and after 12 weeks of eccentric isokinetic training of knee flexors and extensors (3×10 MVC, 2x/week) at 30°/s for extension and flexion torque (isometric; concentric and eccentric at 30 and 120°/s) and functional jump tests (single, triple, cross and figure of 8). Inter- and intra-limb pre- and post-training mean peak torque (MPT), distance and jump test times were compared along with the correlations between these variables, considering P<0.05. Results: The affected limb (AL) showed significant gain of extension and flexion torque (P<0.01) in the different test categories and velocities evaluated. In the non-affected limb (NAL), this only occurred in the eccentric category (30 and 120°/s), in the extension (P<0.01) and flexion (P<0.05 and P<0.01) torques, respectively. In the jumps, there was an increase in distance (single and triple; P<0.05) and a decrease in time (crossed and figure of 8; P<0.01), however, MPT x Jump correlations were weak (r<0.3) in the pre and post-training period in both limbs. Conclusion: Despite the gain in knee extension and flexion torque and jumping performance, the expected correlation was not satisfactory, suggesting that knee functionality involves other variables inherent to motor control. Level of Evidence IV; Type of study: Case series.

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Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament—Clinical Results after a Long-Term Follow-Up

Joints ◽

10.1055/s-0038-1653950 ◽

2018 ◽

Vol 06 (02) ◽

pp. 075-079 ◽

Cited By ~ 11

Author(s):

Paolo Parchi ◽

Gianluca Ciapini ◽

Carlo Paglialunga ◽

Michele Giuntoli ◽

Carmine Picece ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Rating Scale ◽

Cruciate Ligament ◽

Case Series ◽

Retrospective Case ◽

Level Of Evidence ◽

Patient Reported ◽

Anterior Cruciate

Purpose The aim of this retrospective study was to evaluate the subjective and functional outcome of anterior cruciate ligament (ACL) reconstruction with the synthetic Ligament Advanced Reinforcement System (LARS) ligament. Methods Twenty-six patients were reviewed at an average follow-up of 11.6 years. Objective clinical evaluation was performed with stability tests. Patient-reported outcomes (Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and Cincinnati Knee Rating Scale) were used to assess subjective and functional outcomes. Results Overall satisfactory results were obtained in 22 cases (84.6%). Four patients (15.4%) showed mechanical failure of the graft. No cases of synovitis or infection were reported. Conclusion LARS ligament can be considered a safe and suitable option for ACL reconstruction in carefully selected cases, especially elderly patients needing a rapid postoperative recovery. Level of Evidence Level IV, retrospective case series.

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Mobile Web-Based Follow-up for Postoperative ACL Reconstruction: A Single-Center Experience

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117745278 ◽

2017 ◽

Vol 5 (12) ◽

pp. 232596711774527 ◽

Cited By ~ 8

Author(s):

James Higgins ◽

John Semple ◽

Lucas Murnaghan ◽

Sarah Sharpe ◽

John Theodoropoulos

Keyword(s):

Acl Reconstruction ◽

Mobile Application ◽

Controlled Trial ◽

Cruciate Ligament ◽

Case Series ◽

Postoperative Treatment ◽

Level Of Evidence ◽

Current Application ◽

Orthopaedic Patients

Background: The initial 6 weeks after surgery has been identified as an area for improvement in patient care. During this period, the persistence of symptoms that go unchecked can lead to unscheduled emergency room and clinic visits, calls to surgeons’ offices, and readmissions. Purpose: To analyze postoperative data from a previous study examining postoperative outcomes in 2 patient populations following breast reconstruction and anterior cruciate ligament (ACL) reconstruction with use of a patient-centered mobile application. Here, the authors establish whether this method of follow-up can provide useful insight specific to the orthopaedic patient population, and they determine whether the mobile platform has the potential to modify their postoperative treatment. In addition, the authors examine its utility for orthopaedic physicians and patients. Study Design: Case series; Level of evidence, 4. Methods: Eligible patients undergoing ACL reconstruction from 2 surgeons were consecutively recruited to use a mobile smartphone application that allowed physicians to monitor their recovery at home. Data from 32 patients were collected via the application and analyzed to evaluate recovery trends during the first 6 postoperative weeks. Following completion of the study, patients and physicians were interviewed on their experience. Results: Data collected from each question in the mobile application provided insightful trends on daily real-time indicators of postoperative recovery. The application identified 1 patient who required in-person reassessment to rule out a possible infection, following surgeon review of an uploaded image. It was estimated that the majority of patients could have avoided follow-up at 2 and 6 weeks, owing to the application’s efficacy. Participants described their satisfaction with the device as excellent (43%), good (40%), fair (10%), and poor (7%), and 94% (n = 30) of patients reported that they would respond to questions using a similar application in the future. Both physicians rated their experience as positive and identified useful traits in the web portal. Conclusion: This system can accurately assess patient recovery; it has the potential to change how postoperative orthopaedic patients are followed, and it is well received by patients and physicians. Recognition of the study’s limitations and employment of user feedback to improve the current application are essential before a formal randomized controlled trial is conducted.

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The Top 100 Most Cited Articles on Anterior Cruciate Ligament Reconstruction: A Bibliometric Analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120976372 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712097637

Author(s):

Ning Tang ◽

Wenchao Zhang ◽

Daniel M. George ◽

Yang Su ◽

Tianlong Huang

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Sports Medicine ◽

Cruciate Ligament ◽

Knee Injuries ◽

The United States ◽

Anatomic Reconstruction ◽

Level Of Evidence ◽

Cross Sectional ◽

Anterior Cruciate

Background: The concept of anterior cruciate ligament (ACL) reconstruction (ACLR) has become widely accepted, gaining increased attention in recent years and resulting in many research achievements in this field. Purpose: The aim of this study was to determine which original articles on ACLR have been most influential in this field by identifying and analyzing the characteristics of the 100 most cited articles. Study Design: Cross-sectional study. Methods: Articles on ACLR were identified via the Thomson ISI Web of Science database on November 30, 2019. The 100 most cited articles were identified based on inclusion and exclusion criteria. The data extracted from each article for the subsequent analysis included title, date of publication, total citations, average citations per year (ACY), journal name, first author, institutions, themes, level of evidence, and keywords. Results: The total number of citations was 29,629. The date of publication ranged from 1975 to 2015. A majority of the articles originated from the United States (58%) and were published in the 1990s (32%) and 2000s (48%). The mean ACY was 18.43 ± 9.51. Of the selected articles, nearly one-half were published in the American Journal of Sports Medicine (42%). The most prolific co-author and first author were Freddie H. Fu (n = 13) and K. Donald Shelbourne (n = 5), respectively. The most productive institution was the University of Pittsburgh (14%). Material comparison (19%) and technique comparison (16%) were the 2 most popular themes. More than one-quarter of articles were level 4 evidence (37%). Moreover, the keywords ACL, ACL reconstruction, ACL rupture, knee joint, knee injuries, and human showed the highest degree of centrality. Conclusion: By analyzing the characteristics of articles, this study demonstrated that ACLR is a growing and popular area of research, with the focus of research varying through timeline trends. Studies on anatomic reconstruction and biomechanics might be areas of future trends.

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Lateral location of the tibial tunnel increases lateral meniscal extrusion after anatomical single-bundle anterior cruciate ligament reconstruction

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000303 ◽

2019 ◽

Vol 4 (6) ◽

pp. 285-289

Author(s):

Takeshi Oshima ◽

Samuel Grasso ◽

Aaron Beach ◽

Brett Fritsch ◽

David A Parker

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Case Series ◽

Single Bundle ◽

Characteristic Analysis ◽

Meniscal Extrusion ◽

Level Of Evidence ◽

Anterior Cruciate

IntroductionThe tibial footprint of the anterior cruciate ligament (ACL) overlaps with the anterior lateral meniscal root (ALMR), and there is a possibility that an anatomical tibial tunnel reaming might damage the attachment of ALMR. The aim of this study was to investigate the relationship between tibial tunnel location and lateral meniscal extrusion (LME) after anatomical single-bundle ACL reconstruction.MethodsA prospectively collected database and associated intraoperative findings for 153 patients undergoing primary anatomical ACL reconstruction between October 2014 and July 2016 were investigated. Those cases with no meniscal injury seen at surgery and meeting the criteria (52/153) were included. Tibial plateau length (TPL), width (TPW), tibial tunnel location and LME were evaluated from postoperative high-resolution MRI. The location of the centre of the tibial tunnel was evaluated by the position relative to the medial tibial eminence with two measures, the medial–lateral distance (MLD) and anterior–posterior distance. These measures were expressed as a percentage of the TPW and TPL, respectively. The LME was also expressed as a percentage of TPW and correlated with tibial tunnel location.ResultsThere was a positive correlation between percentage of LME (%LME) and percentage of MLD (%MLD) (r=0.478; p<0.001). Applying receiver operating characteristic analysis, we determined that a cut-off value of 4 %MLD was significant. The mean percentage of LME was 1.20 for >4 %MLD, compared with 0.17 for ≤4 %MLD (p<0.001). No significant correlation was found between %LME and clinical outcomes at 1-year follow-up.ConclusionLateral location of the tibial tunnel increases the rate of LME after single-bundle ACL reconstruction.Level of evidenceLevel IV, Case series.

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Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft

Joints ◽

10.11138/jts/2015.3.3.102 ◽

2015 ◽

Vol 03 (03) ◽

pp. 102-108 ◽

Cited By ~ 5

Author(s):

Shuji Taketomi ◽

Hiroshi Inui ◽

Kensuke Nakamura ◽

Ryota Yamagami ◽

Keitaro Tahara ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Soft Tissue ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Case Series ◽

Femoral Fixation ◽

Bptb Graft ◽

Anterior Cruciate ◽

Bone Plug ◽

Rectangular Tunnel

Purpose: the efficacy and safety of using a suspensory button for femoral fixation in anatomical anterior cruciate ligament (ACL) reconstruction with bonepatellar tendon-bone (BPTB) graft have not been established. The purpose of the current study was to evaluate bone plug integration onto the femoral socket and migration of the bone plug and the EndoButton (EB) (Smith & Nephew, Andover, MA, USA) after rectangular tunnel ACL reconstruction with BPTB autograft. Methods: thirty-four patients who underwent anatomical rectangular ACL reconstruction with BPTB graft using EB for femoral fixation and in whom three-dimensional (3D) computed tomography (CT) was performed one week and one year after surgery were included in this study. Bone plug integration onto the femoral socket, bone plug migration, soft tissue interposition, EB migration and EB rotation were evaluated on 3D CT. The clinical outcome was also assessed and correlated with the imaging outcomes. Results: the bone plug was integrated onto the femoral socket in all cases. The incidence of bone plug migration, soft tissue interposition, EB migration and EB rotation was 15, 15, 9 and 56%, respectively. No significant association was observed between the imaging outcomes. The postoperative mean Lysholm score was 97.1 ± 5.0 points. The postoperative side-to-side difference, evaluated using a KT-2000 arthrometer, averaged 0.5 ± 1.3 mm. There were no complications associated with EB use. Imaging outcomes did not affect the postoperative KT side-to-side difference. Conclusions: the EB is considered a reliable device for femoral fixation in anatomical rectangular tunnel ACL reconstruction with BPTB autograft. Level of evidence: Level IV, therapeutic case series.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211029228 ◽

2021 ◽

Vol 9 (9) ◽

pp. 232596712110292

Author(s):

Dimitrios Kitridis ◽

Ioannis Tsifountoudis ◽

Dimitrios Georgiannos ◽

Konstantinos Tsikopoulos ◽

Panagiotis Givissis ◽

...

Keyword(s):

Computed Tomography ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Case Series ◽

Single Bundle ◽

Anatomic Acl Reconstruction ◽

Level Of Evidence ◽

Notch Width ◽

Ct Analysis

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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