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

Thompson, Rory; Hamilton, David; Murray, Iain; Lawson, Graham


Rory Thompson

David Hamilton

Iain Murray

Graham Lawson


Despite influencing knee biomechanics and outcomes, the use of notchplasty at time of anterior cruciate ligament reconstruction (ACLR) has not been evaluated with regards to risk of secondary injury and revision. This study evaluates this association.

42 patients (21.7-years, IQR = 19.0–27.5) that underwent primary then revision ACLR at a single institution were contrasted with a case matched control group of patients with grafts that did not fail. Patients were propensity score matched in a 1:2 ratio by age, gender, and date of index procedure. Post-hoc statistical correction was made for post-index procedure sports participation level.

Notchplasty was performed in 2 of 42 cases that went on to revision, and in 31 of 84 cases in the control group (p < 0.001). This was associated with reduced rates of revision ACLR (OR = 0.085, 95%CI = 0.019–0.378). A significant difference was seen in the post-ACLR activity level between groups (p = 0.028), with post-hoc testing highlighting those returning to competitive sport to be more likely to require subsequent revision (OR = 9.647, 95%CI = 1.947–47.795). Notchplasty remained significantly associated with (reduced) risk of revision surgery, despite the observed variation in post-ACLR activity (p = 0.001).

Individuals whose graft failed following ACLR were significantly less likely to have had notchplasty performed as part of their surgery than a control group who did not suffer graft reinjury. We propose that this may be due to decreased tensioning of the graft as the knee enters dynamic valgus, which may be of great relevance to athletes undergoing ACLR to enable return to sport.

Journal Article Type Article
Acceptance Date May 31, 2022
Online Publication Date Jun 20, 2022
Publication Date 2023-07
Deposit Date Aug 16, 2022
Journal European Journal of Orthopaedic Surgery & Traumatology
Print ISSN 1633-8065
Electronic ISSN 1432-1068
Publisher Springer
Peer Reviewed Peer Reviewed
Volume 33
Pages 1533–1539
Keywords Notchplasty, Anterior cruciate ligament, Revision, ACL
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