title: Notchplasty in anterior cruciate ligament reconstruction in the setting of passive anterior tibial subluxation.
abstract: OBJECTIVE
  In an effort to minimize graft impingement among various ACL deficient states, we sought to quantitatively determine requirements for bone resection during notchplasty with respect to both volumetric amount and location.
  
  
  METHODS
  A validated method was used to evaluate Magnetic Resonance Imaging scans. We measured the ATT of the medial and lateral compartments in the following four states: intact ACL (27 patients), acute ACL disruption; <2 months post-injury (76 patients), chronic ACL disruption; 12 months post-injury (42 patients) and failed ACL reconstruction (75 patients). Subsequently, 11 cadaveric knees underwent Computed Tomography (CT) scanning. Specialized software allowed virtual anterior translation of the tibia according to the average ATT measured on MRI. Impingement volume was analyzed by performing virtual ACLRs onto the various associated CT scans. Location was analyzed by overlaying an on-screen protractor. The center of the notch was defined as 0°.
  
  
  RESULTS
  Average impingement volume changed significantly in the various groups compared to the intact ACL group (acute 577 ± 200 mm(3), chronic 615 ± 199 mm(3), failed ACLR 678 ± 210 mm(3), p=0.0001). The location of the required notchplasty of the distal femoral wall border did not change significantly. The proximal femoral border moved significantly towards the center of the notch (acute 8.6° ± 4.8°, chronic 7.8° ± 4.2° (p=0.013), failed ACLR 5.1° ± 5.9° (p=0.002)).
  
  
  CONCLUSIONS
  Our data suggests that attention should be paid peri-operatively to the required volume and location of notchplasty among the various ACL deficient states to minimize graft impingement.
authors.affiliation: Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States. Electronic address: hazuiderbaanmd@gmail.com.
authors.forename: Hendrik A
authors.initials: HA
authors.lastname: Zuiderbaan
authors.affiliation: Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States. Electronic address: khamaisys@hss.edu.
authors.forename: Saker
authors.initials: S
authors.lastname: Khamaisy
authors.affiliation: Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States. Electronic address: nawabid@hss.edu.
authors.forename: Danyal H
authors.initials: DH
authors.lastname: Nawabi
authors.affiliation: Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States. Electronic address: theinr@hss.edu.
authors.forename: Ran
authors.initials: R
authors.lastname: Thein
authors.affiliation: Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States. Electronic address: nguyenj@hss.edu.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Nguyen
authors.affiliation: Department of Biomechanics and Implant Design, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States. Electronic address: lipmanj@hss.edu.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Lipman
authors.affiliation: Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States. Electronic address: pearlea@hss.edu.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Pearle
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000473:pathology / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D002102:Cadaver; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D013977:Tibia / Q000601:surgery; D017211:Treatment Failure
keywords: Anterior cruciate ligament; Anterior cruciate ligament reconstruction; Anterior tibial translation; Notchplasty; Revision