180 / 244
179
PURPOSE AND
INTRODUCTION OF THE
STUDY
Several ACL rupture occur without any exterior
factor. This can happen through a mechanism
of tiredness by a repeated twisting and tension
on the ACL, or by conflict with the lateral
femoral condyle when the knee twists. These
are intrinsic factors.
Two of the most frequent cases are: a high
tibial slope, exceeding 10° [10], which is
describe as a mechanical factor of anterior
translation and also an intercondylar notch
stenosis which is responsible for stress on the
ACL in tibial rotation [1].
The purpose of this study is to analyse the
benefits of a notch plasty while the ACL is
being repaired by arthroscopy in order to
prevent ACL rupture recurrence in the narrow
intercondylar notch.
AUTHORS ANALYSIS
Some authors have witnessed a significant
difference in the intercondylar notch size index
compared to the ACL rupture. They have found
a correlation in the prevalence of non contact
ACL rupture with a narrow intercondylar notch
which creates an impingement between ACL
and the lateral condyle of the femur.
The non contact ACL injury supposes that
there is a stenosis of inter-condylar notch. The
case of an ACL rupture is different between a
slow traumatic injured knee in external rotation
and an highly impacted injury of the knee.
Those slow traumatic injured ACLs are not
associated with a medial collateral ligament
injuried.
We have used the Souryal index in this study
[1]. Usually a 22% index is considered as a
limit between the normal width notch and the
narrow width notch. This index is usefull even
in CT Scan (Anderson) or in MRI (Herzog) and
the size or sexe of the patient is not taken into
consideration. An index over 26% is considered
as large.
The purpose of the narrow width notch is to
consider that it is a intrinsic factor of ACL
rupture in slow mecanism. But this analysis is
not accepted by all the authors [2-4-5-8].
This index based on a 902 ACl study group
showed a significant difference between ACL
injury and a narrow inter-condylar index. But
others studies have shown a non significant cor
relation of narrow notch in the bilateral cases.
NOTCH PLASTY IN ACL
RECONSTRUCTION
L. BUISSON, G. ESTOUR, A. PINAROLI