Secondary arthrofibrosis is caused by immobilization and infection [3, 4] or poor surgical technique, causing graft friction due to positioning of the tibial fixation tunnel too anteriorly , inadequate notchplasty
or too large size of the graft [6, 7].
Gasparini, "Effects of notchplasty
on anterior cruciate ligament reconstruction: a systematic review," Joints, vol.
Arthroscopic decompression of central acetabular impingement with notchplasty
. Arthrosc Tech 2014;3:e555-8.
Caption: Figure 4 Femoral notch after notchplasty
. Note the complete absence of the ACL, and the hypoplastic remnant of the PCL.
She underwent a notchplasty
and a transtibial single-bundle ACL reconstruction with anterior tibialis tendon allograft.
In chronic cases, notchplasty
may be applied in order to enlarge the narrowed intercondylar notch [8, 27, 28].
As there were no bony deformities, corrective osteotomy or sigmoid notchplasty
were not performed.
The effect of intercondylar notchplasty
on the normal canine stifle.
The femoral and tibial tunnels are then created under arthroscopic guidance and a notchplasty
is performed if necessary.
--intraoperative [8, 18]: improper graft choice, graft harvest errors, inadequate notchplasty
, improper tunnel placement, femoral tunnel blowout, dropped graft, graft laceration, graft-construct mismatch, screw-tunnel divergence, improper tensioning, inadequate graft fixation;
The prevention of this phenomenon as first delineated by Jackson and expanded by others includes attention to tunnel positioning and notchplasty
to avoid impingement, debridement of the tibial tunnel before the graft is advanced, and removal of osteocartilagenous fragments.
Often a notchplasty
of the inferior and posterior aspects of the corresponding condyle must be performed to reach the posterior horn.