Notchplasty in anterior cruciate ligament reconstruction: A systematic review of clinical outcomes

Introduction: Notchplasty is an adjuvant procedure performed during Anterior Cruciate Ligament reconstruction (ACLR) with the purpose of widening the intercondylar notch of the femur. Its use is controversial due to its biomechanical influence on the knee and the potential for increased complications. The purpose of this systematic review is to evaluate the outcomes of patients who underwent ACLR with notchplasty. Materials and methods: A systematic search of Cochrane, Embase, and Medline was conducted to identify papers evaluating clinical outcomes of patients who underwent ACLR with notchplasty. Inclusion criteria encompassed human studies with a control group, reporting clinical outcomes such as graft failure, graft rupture, range of motion values, and patient-reported outcomes. Results: A total of 4 studies were included comprising 396 patients (129 with notchplasty, 235 without). No significant differences were reported regarding graft survivability or Lysholm score between those with notchplasty and those without. One study reported significantly reduced rates of revision surgery after ACLR with notchplasty. There were conflicting complication rates between studies regarding chronic synovitis and arthrofibrosis. Conclusion: Patients who undergo notchplasty during primary ACLR have similar outcome scores and risk of graft failure compared to those who do not undergo notchplasty. Notchplasty patients may also be at a higher risk for loss of extension and chronic synovitis.