The intercondylar notch (intercondylar fossa) is the deep groove between the medial and lateral femoral condyles on the posterior distal femur, housing the cruciate ligaments within the knee joint. The anterior cruciate ligament arises from the lateral wall of the notch (the medial surface of the lateral condyle); the posterior cruciate ligament arises from the medial wall (the lateral surface of the medial condyle). Notch dimensions vary and narrow notches are associated with higher ACL injury risk.
The intercondylar notch dimensions directly affect ACL injury risk and reconstruction outcomes. Narrow notch width (notch width index less than 0.23) is associated with higher ACL injury rates, particularly in female athletes. During ACL reconstruction, the femoral tunnel is placed on the lateral wall of the notch, and notchplasty (removal of the anterior notch roof) prevents graft impingement in extension. The notch is also the site of cyclops lesion formation (localised arthrofibrosis) after ACL reconstruction that causes a flexion block.
Fibrous tissue formation in the anterior intercondylar notch after ACL reconstruction causes an extension block producing a characteristic clunk at terminal extension (the cyclops sign), requiring arthroscopic debridement of the fibrous nodule from the anterior notch to restore full extension.
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