Impact of selective notchplasty on functional outcomes following ACL reconstruction

Introduction. Anterior cruciate ligament (ACL) injuries are common in sports medicine and may lead to instability and degenerative changes if not treated effectively. Narrow femoral notch morphology (Notch Width Index < 0.25) has been associated with an increased risk of graft impingement and reconstruction failure. Notchplasty, an arthroscopic technique to widen the intercondylar notch, is proposed to prevent graft impingement and restore full knee extension. However, its indications and outcomes remain controversial. Objective. This study aims to assess the functional outcomes of targeted notchplasty in patients with true notch stenosis (Notch Width Index < 0.25) undergoing ACL reconstruction. Methodology. This prospective follow-up study was conducted from April 2020 to June 2024 including 69 patients aged 18–50 years with intraoperative NWI < 0.25. All underwent hamstring autograft ACL reconstruction with notchplasty. Outcomes parameters assessed included pain (VAS), range of motion (ROM), Extension lag, Lysholm scores, and complications, which are evaluated at 1, 3, and 6 months. Data were analyzed using SPSS v25, with paired t-tests and chi-square tests applied to evaluate changes over time (p < 0.05). Result. The mean preoperative Lysholm score improved significantly from 70.34 to 99.43 at 6 months (p < 0.0001). Extension lag was resolved completely within 3 months in all patients (p < 0.001), and knee stability significantly improved, with all patients able to perform daily activities by 1 month and strenuous activities by 3 months. Notchplasty successfully increased the notch width by 2–4 mm. No complications, such as infection, graft failure, or reoperation were observed; however, two patients (2.89%) had persistent flexion deficits at final follow-up. Conclusion. Notchplasty in patients with femoral notch stenosis undergoing ACL reconstruction provides significant improvement in functional outcomes, minimizes extension lag, and has a low complication rate if prudently selected.