Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature

Document Type: CASE REPORT

Authors

1 Orthopedic department, Akhtar Hospital, Shahid-Beheshti University of Medical Sciences

2 Orthopedic surgeon, Orthopedic Department, khatam-Anbia Hospital, Tehran, Iran

3 Avicenna Hospital, Mazandaran University of Medical Sciences, Sari, Iran

4 Trauma Road Research Center, Poursina Hospital, Guilan University Of Medical Sciences, Rasht, Iran

Abstract

 Background: 
A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture.    
Case presentation: 
A 35-year old male soccer player with a history of ACL tear from the previous year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages: first fixation of the fracture and then ACL re-revision after fracture healing was complete. 
Conclusions: 
Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction

Keywords


  1. Han Y, Sardar Z, McGrail S, Steffen T, Martineau PA. Peri-anterior cruciate ligament reconstruction femur fracture: a biomechanical analysis of the femoral tunnel as a stress riser. Knee Surg Sports Traumatol Arthrosc. 2011;19:77-85.
  2. Hofbauer M, Muller B, Murawski CD, Baraga M, van Eck CF, Fu FH. Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction. Knee Surg Sports Traumatol Arthrosc. 2013; 21(9):2072-80.
  3. Julien TP, Ramappa AJ, Rodriguez EK. Femoral condylar fracture through a femoral tunnel eleven years after anterior cruciate ligament reconstruction: a case report. J Bone Joint Surg Am. 2010; 92:963-7.
  4. Mithoefer K, Gill TJ, Vrahas MS. Supracondylar femoral fracture after arthroscopic reconstruction of the anterior cruciate ligament. A case report. J Bone Joint Surg Am. 2005; 87(7):1591-6.
  5. Wilson TC, Rosenblum WJ, Johnson DL. Fracture of the femoral tunnel after an anterior cruciate ligament reconstruction. Arthroscopy. 2004; 20(5):45-7.
  6. Pascual-Garrido C, Carbo L, Makino A.  Revision of anterior cruciate ligament reconstruction with allografts in patients younger than 40 years old: a 2 to 4 year results. Knee Surg Sports Traumatol Arthrosc. 2014; 22(5):1106-11.
  7. Coobs BR, Spiridonov SI, LaPrade RF. Intra-articular lateral femoral condyle fracture following an ACL revision reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(9):1290-3.