Biomechanical effects of femoral notchplasty in anterior cruciate ligament reconstruction

Keith L. Markolf, Sharon L. Hame, D. Monte Hunter, Daniel Oakes, Paul Gause

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Notchplasty is frequently performed in conjunction with anterior cruciate ligament reconstruction. Bench loading tests were performed on 26 fresh-frozen knee specimens to measure excursion of a bone-patellar tendon-bone graft, anterior-posterior laxity of the knee, and graft forces before and after performing a 2-mm and a 4-mm notchplasty. The mean intraarticular pretension required to restore normal anterior-posterior laxity at 30° of flexion (laxity-matched pretension level) was 27 N before notchplasty, 48 N after 2-mm notchplasty, and 65 N after 4-mm notchplasty. The mean graft pretension decreased 53% and 58%, respectively, on completion of a loading test series involving anterior-posterior and constant tibial loading forces. Mean laxity increased 1.4 mm at full extension and decreased 1.8 mm at 90° of flexion after a 2-mm notchplasty. Mean graft forces increased markedly between 30° and 90° of passive flexion after notchplasty. Our results show that after a notchplasty, a higher level of graft pretension will be necessary to restore normal laxity at 30° of flexion. This increased level of pretension, combined with changes in graft excursion, produced dramatic increases in graft force when the knee was flexed to 90°. These relatively high forces would be detrimental to a remodeling graft and could lead to subsequent failure of the reconstruction.

Original languageEnglish (US)
Pages (from-to)83-89
Number of pages7
JournalAmerican Journal of Sports Medicine
Issue number1
StatePublished - 2002
Externally publishedYes

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Orthopedics and Sports Medicine


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