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INTRODUCTION
The revision surgery of anterior cruciate
ligament (ACL) reconstruction is always
challenging for the surgeon and the results are
dependent upon the ability to understand and to
treat the causes of the graft failure. Its incidence
varies between 4,5-20% [1]. The outcome of
revisionACL procedure remains poor compared
to primary ACL reconstruction. The definition
of failure is not universally accepted. Several
authors consider that the surgery is failed in case
of subjective and/or objective knee instability,
persistent pain, stiffness, extensor mechanism
dysfunction or infection. Despite the im
provements in the surgical techniques, the risks
of re-rupture are still high [2].
In literature several intrinsic factors leading to
ACL reconstruction failure are described such
as narrow notch width, increased tibial slope,
high anterior tibial translation, rotatory laxity,
gender, hyper-laxity with recurvatum and
genetic factors. The extrinsic factors are re
presented by technical errors (mainly femoral
tunnel malposition), sports, neuromuscular
aspects, rehabilitation and physical preparation.
It is mandatory to identify and to address all the
modifiable risk factors in order to limit the re-
rupture rate [3, 4].
NOTCH WIDTH
The narrow intercondylar notch was described
by Palmer in 1936 as an anatomical risk factor
for ACL injury, providing less space for the
ligament to function correctly especially in full
extension [4] (fig. 1).
In literature the association between dimension
measurements of the femoral notch and
increased risk of ACL ruptures is well
described. Femoral notch measurements
include the notch width (distance between the
femoral condyles at the anterior outlet), the
notch width index (the ratio of the notch width
to the total condylar width), and the presence of
a bony crest on the anteromedial aspect of the
femoral intercondylar notch that may
predispose individuals to ACL rupture [4].
Zeng
& al.
[5], in a meta-analysis, report that
the narrow intercondylar notch dimensions are
associated with the risk of ACL injury. Besides
the width of the intercondylar notch, its shape
may also play a role in ACL ruptures. Narrow
notches are frequently A- or wave-shaped
while wider notches are more rounded or
reverse U-shaped. A broader and rounded
notch can provide more space for the ACL
when the knee is near or in full extension 4.
Sonnery-Cottet
& al.
[6] confirm that patients
WHAT ARE THE INTRINSIC
FACTORS IN ACL FAILURE?
M. VALOROSO, G. LA BARBERA, G. DEMEY, D. DEJOUR