Arthroscopic Finding of Anterior Cruciate Ligament with Femoral Intercondylar Notch Stenosis

PURPOSE: My goal was to evaluate and summarize the results of treatment of patients with anterior cruciate ligament injury with intercondylar notch stenosis. MATERIALS AND METHODS: I reviewed the 8 anterior cruciate ligament(ACL) injuries with inte#rcondylar notch stenosis treated between November 1996 and August 1999. A study group of 8 consecutive patients underwent a magnetic resonance imaging(MRI) evaluation for unspecified knee pain and swelling. The inetrcondylar notch width were measured with MRI at the notch entrance, at the central notch. Arthro- scopic surgery in all patients was performed. RESULTS: Several patients had clinical symptoms and signs of patello femoral syndrome, unspecified synovitis, etc. that it has limited specific diagnostic value, but nobody showed motion loss of their knees or evidence of instability. MRI demonstrated intrasubstance edema of ACL impling a complete tear in sagittal image. Absolute widths at notch entrance were ranged 11 14mm in men, 10 12mm in women. At the central notch, notch widths measured 13-19mm in men and 11-16mm in women. Arthroscopic finding revealed impingement with whole notch stenosis(5 cases) or with encroachment of lateral notch wall(3 cases). ACLs of all patients were frayed, but those of 2 patients were partially torn. No chondral lesions or degenerative changes were noted. A 3-5mm notchplasty was performed to remove of bone at the anteri- or outlet of the intercondylar notch in all patients. In one patient, the MRI study performed 19 months postoperatively revealed normal ACL signal. I underwent second-look arthroscopy 2 years postoperative- ly in another one patient. The notchplasty site appeared to have minimally recorticated and ACL showed almost normal state. After 17 months of average follow-up, every clinical symptoms and signs was signif- icantly disappeared in 6 patients. On the other hand, 1 patients have intermittent pain and joint swelling over their knees and need some medicine. One of 8 patients had a tear of his ACL at 20 months after notchplasty and underwent anterior cruciate ligament reconstruction. CONCLUSTION: Although the small cases were evaluated, there was a trend that the patients with narrower notches or with encroachment of the lateral walls have abnormal clinical symptoms and signs. I believe that sufficient understanding of the disease and early performance of notchplasty with arthroscopy may prevent the possibility of complete rupture.

Arthroscopic Notchplasty in the Treatment of Flexion Contracuture of Early Osteoarthritic Knee ( a preliminary study ) / 대한정형외과학회잡지

Although causes of restriction of knee extension in osteoarthritis are thought to be contractures involving the posterior capsule and the hamstring muscles, intercondylar notch stenosis, osteophyte, loose body, and displacement of ruptured meniscus, few studies have investigated incidence and treatment. The purpose of this study is to consider intercondylar notch stenosis and anterior impingement as major causes of flexion contracture in osteoarthritic knee and to assess their relationship through arthroscopic notchplasty. We performed arthroscopic notchplasty and debridement in sixty patients (sixty-eight cases) with more than Sflexion contracture for early osteoarthritic knee and compared flexion contracture before and after operation. The average flexion contracture was 13degrees (5degrees-35degrees) before operation and 4degrees (0degrees- 25degrees) immediately after. An average of 9degrees improvement was shown, with 29 cases ( 48% ) showing improvement of over 5degrees. Our study indicates that flexion contracture in the 29 cases (48%) improved by arthroscopic notchplasty was caused by intercondylar notch stenosis and anterior impingement. Arthroscopic notchplasty may beneficially affect those with flexion contracture in early osteoarthritic knee when conservative management of this disease has failed. This is a preliminary study on the immediate postoperative outcome, therefore, long-term follow-up and recurrence rate should be investigated in future studies.