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Tambe DA, Kumar P, Gnany J, Venugopal V, Kandarkar S, Sayed SR. Arthroscopy Assisted Reduction and Internal Fixation of a Lateral Femoral Condyle Fracture after Anterior Cruciate Ligament Reconstruction with Graft Salvage and Reinforced Suspensory Femoral fixation - A Case Report. J Orthop Case Rep 2021; 11:78-81. [PMID: 34790610 PMCID: PMC8576762 DOI: 10.13107/jocr.2021.v11.i07.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/20/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Anterior cruciate ligament (ACL) reconstruction using hamstring tendon graft is a commonly performed orthopedic surgery. Lateral femoral condyle fracture through the femoral tunnel is a rare complication following ACL reconstruction. These cases are reported to be managed in two stages, fracture fixation by open reduction and internal fixation with bone grafting of the femoral tunnel, followed by revision ACL reconstruction after the fracture union. Case Report: A 41-year-old male Kabaddi player underwent right knee arthroscopic ACL reconstruction following an ACL tear in January 2021, sustained a road traffic accident 7 weeks later and developed a lateral femoral condyle fracture. The graft was intact and trapped into the fracture site making fracture reduction difficult. The graft was lax due to the fixed loop button being trapped in the fracture. The patient was treated in a single stage by arthroscopy assisted fracture reduction and fixation with ACL graft salvage and reinforced suspensory femoral graft fixation to plate suspensory fixation. Conclusion: This case is a rare presentation of lateral condyle fracture after ACL reconstruction and both the issues are managed in a single stage with the help of detailed surgical planning, using utmost arthroscopy skills and keeping all the options of fixation devices ready on the table during the surgery.
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Affiliation(s)
- Deepak Anil Tambe
- Department of Orthopaedics, Rural Medical College, Pravara Medical Trust, Loni, Maharashtra, India
| | - Pushpak Kumar
- Department of Orthopaedics, Rural Medical College, Pravara Medical Trust, Loni, Maharashtra, India
| | - Jabez Gnany
- Department of Orthopaedics, Rural Medical College, Pravara Medical Trust, Loni, Maharashtra, India
| | - Vinayak Venugopal
- Department of Orthopaedics, Rural Medical College, Pravara Medical Trust, Loni, Maharashtra, India
| | - Sanket Kandarkar
- Department of Orthopaedics, Rural Medical College, Pravara Medical Trust, Loni, Maharashtra, India
| | - Saif Rammathulla Sayed
- Department of Orthopaedics, Rural Medical College, Pravara Medical Trust, Loni, Maharashtra, India
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Palazzolo A, Rosso F, Bonasia DE, Saccia F, Rossi R. Uncommon Complications after Anterior Cruciate Ligament Reconstruction. JOINTS 2018; 6:188-203. [PMID: 30582108 PMCID: PMC6301892 DOI: 10.1055/s-0038-1675799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 10/07/2018] [Indexed: 02/06/2023]
Abstract
Anterior cruciate ligament reconstruction (ACL-R) is a common surgical procedure, with good outcome in 75 to 97% of the cases. However, different complications have been described including infection, hemarthrosis, deep vein thrombosis (DVT), and pulmonary embolism (PE) with a rate ranging from 1 to 15%. There are few case reports in the literature describing rare complications after ACL-R and they can be divided into: (1) complications related to the fixation device (rupture, migration); (2) fractures (tibial or femoral side); (3) infections due to uncommon bacteria, mycobacterium, and mycosis; (4) rare vascular injuries; (5) nerve injuries; and (6) other rare complications. In case of fixation device rupture or migration, device removal can be easy but the diagnosis may be challenging. Patellar fracture after ACL-R may be related to harvesting and it is not uncommon. Conversely, femoral or tibial fractures are most frequently due to bone weakness related to bone tunnels. Some rare infections related to uncommon bacteria or mycosis are also described with potentially devastating joint damage. Popliteal artery injuries are uncommon in ACL-R but minor vessels damages are described with possible severe consequences for patients. Injuries to the infrapatellar branch of the saphenous nerve are not uncommon in ACL-R. However, there are few case reports also describing injuries to the saphenous nerve, the common peroneal nerve and the sciatic nerve. The aim of this paper is to review the literature describing uncommon complications after ACL-R, giving some more information about diagnosis and treatment.
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Affiliation(s)
- Anna Palazzolo
- Department of Orthopedics and Traumatology, Università degli studi di Torino, Turin, Italy
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano, Turin, Italy
| | | | - Francesco Saccia
- Orthopaedics and Traumatology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano, Turin, Italy
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Kooner S, Gibson E, Clark M. Periprosthetic total knee fracture after remote reconstruction of the anterior cruciate ligament: a case report. J Med Case Rep 2017; 11:276. [PMID: 28958215 PMCID: PMC5621129 DOI: 10.1186/s13256-017-1448-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 09/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Distal femoral fracture is a rare, but significant, postoperative complication of anterior cruciate ligament reconstruction. However, there has not been a reported case of periprosthetic total knee arthroplasty fracture associated with a previous anterior cruciate ligament repair. Case presentation We report the case of a 51-year-old white man with a history of total knee arthroplasty and remote anterior cruciate ligament reconstruction, who presented with a distal femoral periprosthetic fracture at the site of a previous anterior cruciate ligament augmentation staple. Conclusions Based on these findings, it may be important to consider removal of previous anterior cruciate ligament hardware prior to total knee arthroplasty to reduce risk of periprosthetic fracture, which should be determined on a patient-specific basis.
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Affiliation(s)
- Sahil Kooner
- Department of Orthopedics, University of Calgary Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Eric Gibson
- Department of Orthopedics, University of Calgary Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Marcia Clark
- Department of Orthopedics, University of Calgary Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, Alberta, T2N 1N4, Canada
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Heng CHY, Wang BDH, Chang PCC. Distal femoral fracture after double-bundle anterior cruciate ligament reconstruction surgery. Am J Sports Med 2015; 43:953-6. [PMID: 25587183 DOI: 10.1177/0363546514563908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | - Bryan De Hao Wang
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
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Yoon JR, Jeong HI, Wang JH, Jang KM, Yang JH. Tibial plateau fracture after single bundle anterior cruciate ligament reconstruction using post-tie washer-screw fixation. J Orthop Sci 2015; 20:205-8. [PMID: 23801146 DOI: 10.1007/s00776-013-0431-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 06/12/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Jung-Ro Yoon
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 6-2 Dunchon Dong, Kangdong Ku, Seoul, Korea
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Trentacosta N, Fillar AL, Liefeld CP, Hossack MD, Levy IM. Avoiding Complications and Technical Variability During Arthroscopically Assisted Transtibial ACL Reconstructions by Using a C-Arm With Image Intensifier. Orthop J Sports Med 2014; 2:2325967114530075. [PMID: 26535320 PMCID: PMC4555598 DOI: 10.1177/2325967114530075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Surgical reconstruction of the anterior cruciate ligament (ACL) can be complicated by incorrect and variable tunnel placement, graft tunnel mismatch, cortical breaches, and inadequate fixation due to screw divergence. This is the first report describing the use of a C-arm with image intensifier employed for the sole purpose of eliminating those complications during transtibial ACL reconstruction. PURPOSE To determine if the use of a C-arm with image intensifier during arthroscopically assisted transtibial ACL reconstruction (IIAA-TACLR) eliminated common complications associated with bone-patellar tendon-bone ACL reconstruction, including screw divergence, cortical breaches, graft-tunnel mismatch, and improper positioning of the femoral and tibial tunnels. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 110 consecutive patients (112 reconstructed knees) underwent identical IIAA-TACLR using a bone-patellar tendon-bone autograft performed by a single surgeon. Intra- and postoperative radiographic images and operative reports were evaluated for each patient looking for evidence of cortical breeching and screw divergence. Precision of femoral tunnel placement was evaluated using a sector map modified from Bernard et al. Graft recession distance and tibial α angles were recorded. RESULTS There were no femoral or tibial cortical breaches noted intraoperatively or on postoperative images. There were no instances of loss of fixation screw major thread engagement. There were no instances of graft-tunnel mismatch. The positions of the femoral tunnels were accurate and precise, falling into the desired sector of our location map (sector 1). Tibial α angles and graft recession distances varied widely. CONCLUSION The use of the C-arm with image intensifier enabled accurate and precise tunnel placement and completely eliminated cortical breach, graft-tunnel mismatch, and screw divergence during IIAA-TACLR by allowing incremental adjustment of the tibial tunnel and knee flexion angle. Incremental adjustment was essential to accomplish this. Importantly, a C-arm with image intensifier can be used with any ACL reconstruction that incorporates tunnels in the technique, with the expectation of increase in accuracy and precision and the elimination of common complications. CLINICAL RELEVANCE The use of an image intensifier during transtibial ACL reconstruction will substantially reduce the common complications associated with the procedure and improve both accuracy and precision of tibial and femoral tunnel placement. Use of an image intensifier unit is generalizable to an individual surgeon's preferences for graft choices and drilling techniques and will be especially valuable when the intercondylar architecture is altered from injury, time, or prior surgery.
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Affiliation(s)
- Natasha Trentacosta
- Department of Orthopaedics, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Allison Liefeld Fillar
- Department of Orthopaedics, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Cynthia Pierce Liefeld
- Department of Orthopaedics, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Michael D. Hossack
- Department of Orthopaedics, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - I. Martin Levy
- Department of Orthopaedics, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
- I. Martin Levy, MD, Department of Orthopaedics, Montefiore Medical Center/Albert Einstein College of Medicine, 1250 Waters Place, Floor 11, New York, NY 10461, USA (e-mail: )
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Fracture of the lateral femoral condyle through an anterior cruciate ligament graft tunnel. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of ACL reconstruction tunnels on stress in the distal femur. Knee Surg Sports Traumatol Arthrosc 2013; 21:839-45. [PMID: 22527415 DOI: 10.1007/s00167-012-2003-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This study examined the change in femoral stress caused by graft tunnels drilled for anterior cruciate ligament (ACL) reconstruction. Using a computational model, the number, geometry and position of the graft tunnels exits were varied to determine the effect on bone stress. METHODS A finite element model of the distal femur was developed from a CT scan of a cadaveric knee. To assess the model, the strain calculated computationally was compared to experimentally measured strains in eleven unpaired human cadaver femurs. Using the computational model, the number, geometry and position of the graft tunnel exits were varied to determine the effect on bone stress based on the stress concentration factor: the ratio of bone stress with tunnels to intact bone stress. RESULTS The results indicated that the second tunnel in double-bundle ACL reconstruction results in approximately a 20 % increase in the maximum femoral stress as compared to single-bundle reconstruction. The highest stresses occur at the tunnel exits. The position of the tunnel exits effects femoral stress with the stress increasing slightly (AM SCR from 0.7 to 1 and PL SCR from 1.2 to 1.3) when the AM tunnel exit is moved anteriorly and having greater increases as the posterior lateral (PL) tunnel exit is moved laterally (PL SCR from 1.2 to 1.7) or posteriorly (PL SCR from 1.2 to 2). CONCLUSION In anatomical ACL reconstruction, the tunnel entrances are dictated by anatomy; however, there can be variations in tunnel exit positions. Consideration should be given when positioning tunnel exits on the effect on stress in the femur. Moving the PL tunnel exit laterally or posteriorly increases in the stress at the PL tunnel exit.
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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 Suppl 1:S77-85. [PMID: 21562843 DOI: 10.1007/s00167-011-1527-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 04/19/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Sixteen case reports of distal femur fractures as post-operative complications after anterior cruciate ligament (ACL) reconstruction have been described in the literature. The femoral tunnel has been suggested as a potential stress riser for fracture formation. Additionally, double bundle ACL reconstructions may compound this risk. This is the first biomechanical study to examine the significance of a stress riser effect of the femoral tunnel(s) after ACL reconstruction. The hypotheses tested in this study are that the femoral tunnel acts as a stress riser for fracture and that this effect increases with the size of the tunnel (8 mm vs. 10 mm) and with the number of tunnels (1 vs. 2). METHODS Femoral tunnels simulating single bundle (SB) hamstring graft (8 mm), bone-patellar tendon-bone graft (10 mm), and double bundle (DB) ACL reconstruction (7, 6 mm) were drilled in fourth-generation saw bones. These three experimental groups and a control group consisting of native saw bones without tunnels were loaded to failure. RESULTS All fractures occurred through the tunnels in the DB group, whereas fractures did not consistently occur through the tunnels in the SB groups. The mean fracture load was 6,145N ± 471N in the native group, 5,691N ± 198N in the 8 mm SB group, 5,702N ± 282N in the 10 mm SB group, and 4,744N ± 418N in the DB group. The mean fracture load for the DB group was significantly lower when compared to the native, 8 mm SB, and 10 mm SB groups independently (P value = 0.0016, 0.0060, and 0.0038, respectively). The mean fracture loads for neither SB groups were not significantly different from the native group. CONCLUSIONS An anatomically placed femoral tunnel in single bundle ACL reconstruction in our experimental model was not a significant stress riser to fracture, whereas the two femoral tunnels in double bundle ACL reconstruction significantly decreased load to failure. The results support the sparsity of reported peri-ACL reconstruction femur fractures in single femoral tunnel techniques. However, the increased fracture risk in double bundle ACL reconstruction may be a cause for concern and impact patient selection.
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Affiliation(s)
- Yung Han
- Department of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
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Coobs BR, Spiridonov SI, LaPrade RF. Intra-articular lateral femoral condyle fracture following an ACL revision reconstruction. Knee Surg Sports Traumatol Arthrosc 2010; 18:1290-3. [PMID: 19953223 DOI: 10.1007/s00167-009-0995-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 11/06/2009] [Indexed: 11/26/2022]
Abstract
Lateral femoral condyle fractures following an ACL reconstruction are rare. To our knowledge, this is the first case report of a lateral femoral condyle fracture following a revision ACL reconstruction. The patient's fracture was intra-articular, had a significant amount of soft tissue damage, and was further complicated by a large defect involving the bone tunnel from the ACL revision reconstruction. The patient was treated with an open reduction and internal fixation and recovered well.
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Affiliation(s)
- Benjamin R Coobs
- Department of Orthopaedic Surgery, University of Minnesota, R-200, Minneapolis, MN 55454, USA
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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. [PMID: 20360522 DOI: 10.2106/jbjs.i.00408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Terrill P Julien
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, USA
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12
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Intra-articular distal femur fracture extending from an expanded femoral tunnel in an anterior cruciate ligament (ACL) reconstructed knee: a case report. ACTA ACUST UNITED AC 2010; 67:E209-12. [PMID: 19065114 DOI: 10.1097/ta.0b013e3181469f42] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anterior cruciate ligament (ACL) reconstruction is a popular surgery with overall good results. However, postoperative fracture is a serious, albeit, rare complication. Femoral tunnel lysis may cause a stress riser effect leading to distal femur fractures after ACL reconstruction. We report a case in which a patient who underwent ACL reconstruction surgery 18 months before a low-energy twisting mechanism suffered a distal femur fracture requiring open reduction internal fixation.
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Femoral fracture following knee ligament reconstruction surgery due to an unpredictable complication of bioabsorbable screw fixation: a case report and review of literature. J Orthop Traumatol 2009; 11:51-5. [PMID: 20016925 PMCID: PMC2837813 DOI: 10.1007/s10195-009-0079-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 11/17/2009] [Indexed: 12/26/2022] Open
Abstract
We report an unusual case of femoral fracture from minimal trauma, due to the rapid disappearance of a bioabsorbable interference screw used for reconstruction of the posterolateral corner of the knee. The literature on bone tunnel fractures following knee ligament reconstruction surgery is also reviewed.
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Polyzois I, Manidakis N, Graham S, Tsiridis E. An unusual periarticular fracture following ipsilateral anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2009; 17:503-7. [PMID: 19099291 DOI: 10.1007/s00167-008-0694-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Accepted: 11/19/2008] [Indexed: 11/29/2022]
Abstract
We report an unusual pattern of a peri and intra-articular knee fracture following ACL reconstruction. The pattern of injury was opposite to the graft tunnels which contradicts the well established iatrogenic stress riser theory which has been extensively described in the literature. The fractures were reduced anatomically by open means, the graft was found intact and preserved and the fractures were fixed internally protecting the graft and the tunnels. The patient made an uneventful recovery and the post operative MRI scan 12 months later demonstrated bone healing and an intact ACL. When the ACL graft is found intact in this type of injury, the fracture should be fixed around it taking care not to jeopardize its integrity or the tunnels.
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Fukuda TY, Yazbek PM, Bryk FF. Fratura supracondiliana do fêmur durante salto após reconstrução artroscópica do ligamento cruzado anterior. REV BRAS MED ESPORTE 2009. [DOI: 10.1590/s1517-86922009000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXTUALIZAÇÃO: A fratura distal do fêmur é uma das possíveis complicações no período pós-operatório de reconstrução de LCA, porém, de incidência rara. RELATO DE CASO: Descreve-se o caso de um atleta de 34 anos, gênero masculino, no quinto mês de pós-operatório de reconstrução de LCA. O caso evoluía normalmente de acordo com o protocolo estabelecido; o paciente apresentava bom controle e estabilidade sensoriomotora, quando sofreu fratura supracondiliana do fêmur ao realizar um salto durante atendimento fisioterápico. A reconstrução ligamentar foi realizada com enxerto dos músculos flexores do joelho e a fratura, ocasionada posteriormente, reduzida e fixada com placa e parafuso. Dez meses após a redução aberta e fixação interna da fratura, apresenta função regular na escala Lysholm, amplitude de movimento normal e força muscular grau V em flexores e extensores da coxa. DISCUSSÃO: Poucos relatos de caso semelhantes ao presente foram encontrados na literatura; a maioria apresentou fratura do fêmur após a reconstrução do LCA com tendão patelar. Este caso mostra-se relevante pela associação da fratura supracondiliana do fêmur com reconstrução ligamentar com tendões dos flexores, visto que apenas um trabalho seguiu tal direção. Dentre as prováveis causas dessa fratura, destacam-se uma fragilidade óssea por desuso e túnel ósseo femoral de diâmetro maior que o padrão, apesar de não haver consenso em relação a essas alterações. Uma hipótese sugerida pelos autores deste relato é de que o túnel ósseo de fixação do enxerto pode ter sido um intensificador de estresse sobre o local da fratura.
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Montgomery CO, Evans RP. Arthroscopic reduction and internal fixation of a medial femoral condylar fracture after anterior cruciate ligament reconstruction. A case report. J Bone Joint Surg Am 2008; 90:863-8. [PMID: 18381324 DOI: 10.2106/jbjs.g.00392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Corey O Montgomery
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #531, Little Rock, AR 72205, USA
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Salem K, Rees D, Geutjens G. Low velocity bicondylar tibial fracture following ACL reconstruction. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.injury.2006.08.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Arriaza R, Señaris J, Couceiro G, Aizpurua J. Stress fractures of the femur after ACL reconstruction with transfemoral fixation. Knee Surg Sports Traumatol Arthrosc 2006; 14:1148-50. [PMID: 16917784 DOI: 10.1007/s00167-006-0181-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 06/19/2006] [Indexed: 11/25/2022]
Abstract
The ACL reconstruction with hamstring tendons has become increasingly popular, in part because it is assumed that the complication rate associated with the technique and their severity are lower than with patellar tendon. Two cases of stress reaction of the medial supracondylar area of the femur after ACL reconstruction with hamstring tendons using BioTransfix (Arthrex, Naples, FL, USA) devices for fixation within femur are presented. Both patients were professional athletes (one soccer and one basketball player), and it is hypothesized that the accelerated rehabilitation program used might have represented a risk factor for stress fractures when associated with the guide pin exit hole in the medial femoral cortex. To our knowledge, no such cases have been published to date, but it is important to consider this possibility if an unexplained pain arises in the rehabilitation process of an ACL reconstruction using transfemoral fixation.
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Sheps DM, Reed JG, Hildebrand KA, Hiemstra LA. Supracondylar femur fracture after endoscopic anterior cruciate reconstruction using an EndoButton. Clin J Sport Med 2006; 16:428-9. [PMID: 17016122 DOI: 10.1097/01.jsm.0000212411.48801.79] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Wilson TC, Rosenblum WJ, Johnson DL. Fracture of the femoral tunnel after an anterior cruciate ligament reconstruction. Arthroscopy 2004; 20:e45-7. [PMID: 15122156 DOI: 10.1016/j.arthro.2004.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. Patella fractures can occur as a complication after bone-patellar tendon-bone autografts, and few case reports of tibia fractures have been published. Although reports of femur fractures have been published, the causes are attributed to stress risers other than the femoral tunnel. To our knowledge, this is the first case report of a femoral tunnel serving as a stress riser after an ACL reconstruction with bone-patellar tendon-bone autograft. The patient's fracture resulted from minimal trauma and required surgical fixation.
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Affiliation(s)
- Timothy C Wilson
- Department of Orthopaedic Surgery/Sports Medicine, the University of Kentucky, Lexington, Kentucky 40536-0284, USA.
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Moholkar K, Taylor D, O'Reagan M, Fenelon G. A biomechanical analysis of four different methods of harvesting bone-patellar tendon-bone graft in porcine knees. J Bone Joint Surg Am 2002; 84:1782-7. [PMID: 12377908 DOI: 10.2106/00004623-200210000-00007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction with use of bone-patellar tendon-bone graft is commonly performed to treat functional instability of the knee after injury of the anterior cruciate ligament. Patellar fracture is an underreported complication of this procedure, yet it may be a career-ending injury for a professional athlete. The purpose of this study was to design a new technique to procure the patellar bone plug when reconstructing the cruciate ligament with use of patellar tendon. METHODS Fifty-eight knees were harvested from eighteen to twenty-four-month-old pigs. Bone plugs of four geometrical shapes were cored out of the patellae from forty knees (four plug shapes for each of ten knees). Ten knees had no graft removed. Fifty knees were tested for the effects of a single impact. Eight knees (two plug shapes for each of four knees) were tested for the effects of repeated impacts. Data were analyzed statistically with use of an ordinal logistic model. The probability of impact failure of the patella at different energy levels was calculated. RESULTS Impact energy has been shown to have a significant effect on the outcome (p < 0.001). When controlling for energy level, there was a significant difference between the sharp and round corners (p < 0.01). The ordinal logistic model was found to be very good for predicting the outcome of impact testing. The impact energy required to create a 1% probability of complete fracture was 7 J for a patella with a sharp-cornered plug defect, 17 J for a patella with a trapezoidal plug, 22 J for a patella with a sharp-cornered defect with a drill-hole at the corner, 40 J for a patella with a round-cornered defect, and about 49 J for a normal patella. Repeat impact testing substantially damaged the patellae with sharp-cornered defects, as they failed earlier at a lower energy and after a lower number of impacts than did the patellae with round-cornered defects. CONCLUSIONS We propose the use of the round-cornered patellar bone plug when bone-patellar tendon-bone graft is harvested for anterior cruciate ligament reconstruction, to further reduce the small likelihood of a patellar fracture occurring intraoperatively or in the early postoperative rehabilitation phase.
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Affiliation(s)
- Kirti Moholkar
- Department of Orthopaedics, St. Jame's Hospital, Dublin, Ireland.
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Delcogliano A, Chiossi S, Caporaso A, Franzese S, Menghi A. Tibial plateau fracture after arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2001; 17:E16. [PMID: 11288026 DOI: 10.1053/jars.2001.19450] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Complications have been described with each technique for reconstruction of the anterior cruciate ligament (ACL) in the knee, both open and arthroscopically assisted. The authors describe a case of tibial plateau fracture occurring 7 months after an ACL reconstruction using the half tunnel technique. The fracture occurred at the tibial fixation site and required open reduction with internal fixation. To our knowledge, only 2 cases of proximal tibial fracture after patellar tendon autograft ACL reconstruction have been previously reported. The authors hypothesize that patellar tendon harvesting with bone blocks and transosseous tibial tunnel can produce a "stress riser" effect and somehow act synergistically to create decreased strength at the level of proximal tibial metaphysis.
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Affiliation(s)
- A Delcogliano
- Department of Orthopaedics, Catholic University, Rome, Italy.
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24
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Manktelow AR, Haddad FS, Goddard NJ. Late lateral femoral condyle fracture after anterior cruciate ligament reconstruction. A case report. Am J Sports Med 1998; 26:587-90. [PMID: 9689384 DOI: 10.1177/03635465980260042101] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A R Manktelow
- Department of Orthopaedics, Royal Free Hospital National Health Service Trust, London, United Kingdom
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25
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Wiener DF, Siliski JM. Distal femoral shaft fracture: a complication of endoscopic anterior cruciate ligament reconstruction. A case report. Am J Sports Med 1996; 24:244-7. [PMID: 8775130 DOI: 10.1177/036354659602400224] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- D F Wiener
- Massachusetts General Hospital, Boston, 02114-3139, USA
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26
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Friederich NF, Biedert RM. ROLE OF EXTRA-ARTICULAR PROCEDURE. Clin Sports Med 1993. [DOI: 10.1016/s0278-5919(20)30389-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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