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Notchplasty is associated with decreased risk of anterior cruciate ligament graft revision

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Despite influencing knee biomechanics and outcomes, the use of notchplasty at time of anterior cruciate ligament reconstruction (ACLR) has not been evaluated with regards to risk of secondary injury and revision. This study evaluates this association.

Methods

42 patients (21.7-years, IQR = 19.0–27.5) that underwent primary then revision ACLR at a single institution were contrasted with a case matched control group of patients with grafts that did not fail. Patients were propensity score matched in a 1:2 ratio by age, gender, and date of index procedure. Post-hoc statistical correction was made for post-index procedure sports participation level.

Results

Notchplasty was performed in 2 of 42 cases that went on to revision, and in 31 of 84 cases in the control group (p < 0.001). This was associated with reduced rates of revision ACLR (OR = 0.085, 95%CI = 0.019–0.378). A significant difference was seen in the post-ACLR activity level between groups (p = 0.028), with post-hoc testing highlighting those returning to competitive sport to be more likely to require subsequent revision (OR = 9.647, 95%CI = 1.947–47.795). Notchplasty remained significantly associated with (reduced) risk of revision surgery, despite the observed variation in post-ACLR activity (p = 0.001).

Conclusion

Individuals whose graft failed following ACLR were significantly less likely to have had notchplasty performed as part of their surgery than a control group who did not suffer graft reinjury. We propose that this may be due to decreased tensioning of the graft as the knee enters dynamic valgus, which may be of great relevance to athletes undergoing ACLR to enable return to sport.

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Acknowledgements

The authors would like to acknowledge Deborah MacDonald, for her help in registering the project and establishing access to the institutional database under her guardianship, from which data collection was performed.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Orthopaedics, University of Edinburgh, Edinburgh, UK

    Rory Thompson, David Hamilton, Iain Murray & Graham Lawson

  2. Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK

    Rory Thompson

  3. School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK

    David Hamilton

  4. Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK

    Iain Murray & Graham Lawson

Authors
  1. Rory Thompson
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  2. David Hamilton
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  4. Graham Lawson
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Contributions

RPT: originated conception and design of the study, provided data extraction, statistical analysis, and drafting of the manuscript, revising it critically for important intellectual content, and gave final approval of the submitted version; DFH drafted the final manuscript, revising it for critically for important intellectual content, and gave final approval of the submitted version; IRM: Revised the final manuscript for important intellectual content, and gave final approval of the submitted version. GML originated conception and design of the study, revised the final manuscript for important intellectual content, and gave final approval of the submitted version.

Corresponding author

Correspondence to Rory Thompson.

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The authors declare that they have no competing interests.

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All authors give permission to publish.

Ethical approval

Local ethical approval was granted with classification as a database project (REC ref: 11/AL/0079).

Informed consent

No patient contact was required to conduct the study as this was a review of an existing data set.

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Thompson, R., Hamilton, D., Murray, I. et al. Notchplasty is associated with decreased risk of anterior cruciate ligament graft revision. Eur J Orthop Surg Traumatol 33, 1533–1539 (2023). https://doi.org/10.1007/s00590-022-03305-z

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  • DOI: https://doi.org/10.1007/s00590-022-03305-z

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