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Notchplasty is a surgical procedure performed to reshape the intercondylar notch, an area at the base of the femur. The intercondylar notch articulates with the knee and may vary considerably in size or shape. Some variations are not a cause for concern, but in other cases the intercondylar notch develops an abnormality which can cause medical issues. In these situations, a surgeon may recommend a notchplasty to address the problem.
Before delving into the specifics of the notchplasty, it may help to know more about the anatomy of the femur. The femur, the longest bone in the body, has a distinctive set of flared projections at its base known as the lateral and medial condyles. The intercondylar notch lies between the condyles. In a notchplasty, the surgeon focuses on abnormalities within the notch.
Sometimes it is necessary to perform a notchplasty in order to accommodate a graft. In other cases, there may be concern that the anterior cruciate ligament is at risk of rupture or damage due to growths known as osteophytes which sometimes form on the inner side of the lateral condyle of the femur. As the ligament moves, it rubs against the growths and the osteophytes damage it over time. A surgeon can perform a notchplasty to remove the growths and reshape the notch to reduce the risk of damage to this critical knee ligament.
Before this orthopedic procedure is performed, the surgeon will order medical imaging studies to understand what is going on at the base of the femur and to get a preview of the patient's anatomy. The patient will also be screened for risk factors which could make the surgery dangerous. In a conversation with the patient, the surgeon will discuss the surgery, the planned outcome, and the risks, making sure that the patient is aware of the dangers associated with the surgery so that she or he can make an informed choice about whether or not to proceed.
During the procedure, the patient is placed under anesthesia and monitored by an anesthesiologist. Every surgeon approaches a notchplasty differently, and the approach also varies depending on the specific needs of the patient. Assisted by a surgical team, the surgeon will reshape the bone and perform any other needed procedures, such as inserting a graft, before closing the surgical site and sending the patient to recovery. While in recovery from a notchplasty, patients usually need to observe some special precautions including keeping weight off the injured leg at first, and physical therapy may be necessary for some patients to help them rebuild their strength.