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

Area of Science:

• Orthopedic surgery
• Sports medicine
• Radiology

Background:

• Identifying risk factors for reinjury after anterior cruciate ligament reconstruction (ACLR) is critical for developing effective prevention strategies.
• Physeal-sparing ACLR techniques are used in skeletally immature athletes, but failure rates and associated factors require further investigation.

Purpose of the Study:

• To determine if intercondylar notch geometry features on preoperative MRI are associated with failure in physeal-sparing ACLRs performed on skeletally immature athletes.

Main Methods:

• A case-control study comparing 9 failed physeal-sparing ACLRs with 15 age- and sex-matched controls with intact ACLRs.
• Preoperative MRI scans were used to measure notch width index (NWI), notch angle (NA), and intercondylar notch roof inclination angle (RA).

Main Results:

• The failed ACLR group exhibited a significantly smaller NWI in the coronal plane (P < 0.05) and a trend towards a smaller NWI in the axial plane (P = 0.055).
• The failed ACLR group also showed a significantly smaller NA in both coronal (P < 0.05) and axial (P < 0.05) planes.
• A significantly steeper intercondylar notch roof inclination angle (RA) was observed in the failed ACLR group (P < 0.05).

Conclusions:

• Intercondylar notch geometry, specifically NWI, NA, and RA, is associated with ACLR failure in skeletally immature patients.
• A smaller, narrower, and steeper intercondylar notch may predispose young athletes to reinjury after physeal-sparing ACL reconstruction.