Notchplasty

Written by Dr Sheila Strover on March 14, 2025

A notchplasty is a surgical widening of the intercondylar notch, usually performed as part of an anterior cruciate ligament revision to limit future trauma to the reconstructed ligament.

If the roof of the notch is a bit narrow it may cause impingement problems after anterior cruciate ligament reconstruction, and this may be an indication for a notchplasty procedure.

Illustration of the bones at the front of the knee, showing the notch between the two rounded condyles of the femur.

Is notchplasty indicated for the first ACL reconstruction?

Notchplasty is usually reserved for anterior cruciate ligament reconstruction 'revision' rather than being part of the original reconstruction procedure. It would be indicated where bony spurs form at the abraded edges, causing interference with extension, and shredding the original graft to create a 'cyclops lesion'.

This is because notchplasty itself is not without its own complications.

[A surgeon needs to be]...."aware of potential complications following notchplasty during [anterior cruciate ligament reconstruction] before deciding to perform notchplasty in primary cases....[and] reserving it for the surgical management of arthrofibrosis, treatment of notch osteophytosis and revision ACLR."

Francesco Ranuccio et al

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How is notchplasty performed?

A small osteotome (like a chisel), the rotating burr of a 'shaver' instrument or a radiofrequency diathermy device may all be used to abrade the lateral side of the notch to widen it.

The surgeon will take care to remove all debris, which could otherwise cause later problems.

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Complications of notchplasty

The most important immediate complications is bleeding (haemarthrosis) from the abraded bone surface or the tunnels made to accommodate the graft in the bone, which bleeding is usually evident immediately after the tourniquet has been released after surgery.

The surgeon may attempt to stop the bleeders, or the team may decide to rely upon compression bandaging and drains.

....the main cause of hemarthrosis is cancellous bone bleeding from bone tunnels.....Therefore, optimal tunnel width and tight fit of the graft in the tunnel may prevent postoperative hemarthrosis...."

Oğuzhan Çimen et al

Later complications may include some biomechanical instability, formation of bony outgrowths (osteophytes) on the edge of the abraded surface and soft tissue adhesions on the new ligament.

....Aggressive intercondylar notchplasty may cause notch regrowth, as well as articular cartilage histopathologic changes, consistent with early degenerative arthrosis....."

Dimitrios Kitridis et al

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A-Z Keywords -

Courses -

Frank R Noyes - 2008 - ACL reconstruction failure and revisions

Forum discussions -

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