Introduction: Identifying risk factors is crucial for developing strategies that minimize reinjury after anterior cruciate ligament reconstruction (ACLR). This study aims to determine whether certain features of intercondylar notch geometry are associated with failure of physeal-sparing ACLRs in skeletally immature athletes. Methods: Nine failed physeal-sparing ACLRs were compared with a control subject group of 15 age- and sex-matched intact physeal-sparing ACLRs. Notch width index (NWI), notch angle (NA), and intercondylar notch roof inclination angle (RA) were measured on preoperative MRIs. Results: Median NWI was smaller in the failed ACLR versus control subject group in coronal (0.23 versus 0.27; P &lt; 0.05) and axial planes (0.25 versus 0.27; P = 0.055). Median NA was smaller in the failed ACLR versus control subject group in coronal (49.6 versus 61.0°; P &lt; 0.05) and axial planes (48.6° versus 54.9°; P &lt; 0.05). Median RA was steeper in the failed ACLR versus control subject group (132.0° versus 125.7°; P &lt; 0.05). Conclusion: NWI, NA, and RA were associated with ACLR failure in skeletally immature patients undergoing physeal-sparing reconstruction. A smaller, narrower, and steeper notch may predispose these patients to reinjury. Level of Evidence: Level III, retrospective comparative study.

Stenotic Intercondylar Notch as a Risk Factor for Physeal-Sparing ACL Reconstruction Failure: A Case-Control Study