Femoral Condylar Fracture Through a Femoral Tunnel Eleven Years After Anterior Cruciate Ligament Reconstruction

Distal Femoral Fracture After Double-Bundle Anterior Cruciate Ligament Reconstruction Surgery

“…All reported cases of peri-ACL femoral fractures in the literature so far have occurred after single-bundle ACL reconstruction. Various reasons have been proposed, such as tenodesis screw fixation, 12 use of a cross-pin 5,6,11 or staple, 8 and removal of a transverse cancellous screw. 13 Some authors believe that multiple cortical passes with a guide pin 14,17 or drill 12 may have contributed to the weakening of the bone.…”

Periprosthetic total knee fracture after remote reconstruction of the anterior cruciate ligament: a case report

“…Patients with supracondylar fractures tended to have extra-articular points of ACL ligament fixation, which was in keeping with the results of our case study [ 1 , 2 , 9 , 13 , 16 , 17 , 19 – 21 ]. Only one case study demonstrated fracture after remote ACL reconstruction 11 years postoperatively, while most studies reported fractures within 1 to 2 years of the initial operation [ 2 , 6 ]. Given the high frequency of ACL reconstructions and TKAs performed worldwide, we believe that previous ligamentous reconstructive surgeries may be an important adjunctive risk factor predisposing to TKA periprosthetic fractures.…”

Uncommon Complications after Anterior Cruciate Ligament Reconstruction

“…Femoral fracture following ACL-R is a rare but devastating complication and it was mostly due to technical errors or to the creation of additional bone holes for supplemental fixation devices. Different authors described a decreased bone mineral density up to 20% following knee ligament injury that may be involved in the development of femoral fractures during or after ACL-R. 59 In most of the case reports of femoral fracture after ACL-R, an extra-articular fixation with a 6.5 mm screw, 60 staple, 61 cross-pin, 62 63 64 65 or additional removal of a 6.5 mm transverse cancellous screw 66 were related to this complication. Other authors reported multiple cortical passes with the guide pin 67 68 or drilling for screw placement 60 as possible risk factor associated for fracture development.…”

“…75 Different grafts were used in the other case reports: gore-tex graft was used in one case, 70 BPTB graft was chosen in four cases, 29 68 69 71 and hamstring graft was used in the remaining cases. 61 62 64 66 67 75 76 In most of the cases the fracture was due to a low energy trauma, such as knee twisting 64 70 71 76 and light fall. 29 61 69 In four cases a stress fracture was described.…”

“…Internal fixation with intramedullary nail was performed in three cases with one good outcome, 71 one case of postoperative ROM reduction 68 and one case of mild instability. 66 Four cases were treated with screws with complete recovery 29 61 64 . In one case there was a fracture displacement 3 months after screws fixation.…”