Systematic Notchplasty in Primary ACL Reconstruction Using Hamstring Autografts: A Prospective Cohort Study on the Rate of Secondary Arthrolysis

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Background: Arthrofibrosis requiring arthrolysis is a relevant complication after anterior cruciate ligament (ACL) reconstruction. It has been suggested that intercondylar notch impingement may contribute to this outcome. The aim of this study was to evaluate whether systematic notchplasty during primary ACL reconstruction with hamstring autografts reduces the rate of secondary arthrolysis. Methods: Two groups of patients undergoing primary ACL reconstruction were compared: 149 patients without notchplasty and 140 patients with notchplasty, each with a minimum follow-up of 2 years. The incidence of arthrolysis and other complications, functional outcome scores, and return-to-sport data were analyzed. Results: No significant difference was observed in the rate of arthrolysis: Seven patients (4.7%) were in the non-notchplasty group, with seven patients (5.0%) in the notchplasty group (p = n.s.). Functional outcomes were comparable between groups, with mean subjective IKDC of 86.5, KOOS of 87.5, and Lysholm of 90.9. Return-to-sport rates were similar, and over 90% of patients in both groups reported being satisfied or very satisfied with their outcome. Conclusions: Systematic notchplasty during primary ACL reconstruction with hamstring autografts did not reduce the rate of secondary arthrolysis in this underpowered cohort. Arthrofibrosis is multifactorial, and larger studies are needed to clarify whether notchplasty has an independent effect.

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