Fracture of the supracondylar femur after anterior cruciate ligament reconstruction using patellar tendon and iliotibial band tenodesis

Abstract

Surgical management of the chronic ACL-deficient knee can present a difficult problem, even to the experienced surgeon. Although many procedures are commonly performed, they are not without specific risks.l2 Well-established complications of surgical reconstructions include patellar fracture,l8 patellar tendon rupture,' loss of motion,1O,l9 infection, and hardware failure.&dquo; We present a case of a 29-year-old man who had an ACL reconstruction using autogenous patellar tendon graft and an iliotibial band tenodesis. Six months postoperatively, he sustained a fracture at the level of the iliotibial band screw, requiring open reduction and internal fixation. To the authors' knowledge, this complication has not been previously reported. CASE REPORTA 29-year-old man was evaluated at our outpatient clinic for recurrent instability of the right knee. The patient was an avid recreational athlete who had injured his knee 4 years earlier while playing basketball. He noted that the injury was associated with an audible &dquo;pop,&dquo; immediate swelling, and inability to continue playing, but he did not seek medical attention at that time.At the initial evaluation, the patient complained of moderate medial knee pain and giving way with activities requiring running or pivoting. His medical history was otherwise unremarkable.Physical examination revealed a well-developed man with moderate right quadriceps atrophy, a mild joint effusion, and moderate medial joint line tenderness. Range of motion was 0° to 110°, with moderate discomfort at terminal flexion.Further examination revealed positive Lachman and anterior drawer tests, as well as a moderate pivot shift. There was no evidence of either a posterior sag or posterior drawer. Anteroposterior and lateral radiographs of the involved knee were unremarkable (Fig. 1).Initially, treatment was directed toward improving lower extremity strength and range of motion. Despite a wellsupervised trial of physical therapy, the patient's symptoms of instability did not improve. After some discussion, he agreed with our recommendation for an arthroscopic meniscal debridement and an intraarticular reconstruction using the central third of the patellar tendon (bone-tendon-bone). Diagnostic arthroscopy revealed an old complete tear of the ACL and a small radial tear within the substance of the medial meniscus. The posterior cruciate ligament and lateral meniscus were intact.A partial medial meniscectomy was performed, leaving a large stable rim. The patellar graft was harvested in the standard fashion with its bony attachments.' Isometrically determined bony tunnels were created in the femur and tibia using arthroscopic assistance and C-loop drill guides. The graft was then passed through the tunnels and was provisionally secured. At this point, examination of the knee revealed a full range of motion with only a trace positive Lachman test and elimination of the pivot shift. The graft was secured with interference screws and an extraarticular tenodesis of the iliotibial band was performed....

Supracondylar Femur Fracture After Endoscopic Anterior Cruciate Reconstruction Using an EndoButton

“…[1][2][3][4][5][6][7] Of these, 3 involved fracture of the lateral femoral condyle, and 4 were described as a supracondylar fracture of the femur. Two of the four cases of supracondylar femur fracture occurred at the site of the extraarticular fixation, with 1 at the site of fixation of a ligament augmentation device and the other at the site of fixation of an iliotibial band tenodesis.…”

“…Two of the four cases of supracondylar femur fracture occurred at the site of the extraarticular fixation, with 1 at the site of fixation of a ligament augmentation device and the other at the site of fixation of an iliotibial band tenodesis. 3,4 The third case occurred through the femoral tunnel used for placement of a GORE-TEX prosthetic graft. 5 The fourth case occurred as a result of multiple passes with a trochar pin.…”

Fratura supracondiliana do fêmur durante salto após reconstrução artroscópica do ligamento cruzado anterior

“…Foram encontrados poucos relatos semelhantes ao do presente e, dentre eles, apenas quatro casos (1,7,8) utilizaram enxerto de tendão dos flexores para reconstrução do LCA. Quanto ao local da fratura, apenas Noah et al (4) , Ternes et al (5) , Radler et al (6) e Sheps et al (8) relataram fraturas supracondilianas como complicação de reconstrução de LCA. Entretanto, dentre todos os casos descritos até o momento, apenas Sheps et al (8) descrevem caso com associação de fratura supracondiliana do fêmur e reconstrução de LCA com enxerto de tendão de flexores de perna.…”

“…Dentre as possíveis complicações no período pós-operatório de reconstrução do LCA, a fratura supracondiliana raramente ocorre. Segundo escassos relatos de caso (4)(5)(6) encontrados na literatura, esse tipo de fratura ocorreu após reconstrução com enxerto proveniente do terço médio do tendão patelar, em sua maioria.…”

Low velocity bicondylar tibial fracture following ACL reconstruction

“…Salem et al (supra-condyler, lateral femoral condyle, patellar and lateral tibial plateau) remain a potential risk. 2,3,5,11 With evidence suggesting a quicker return to sports following a bone-tendon-bone graft, 8,9 the creation of a stress raiser in the affected knee is inevitable, this pushed some surgeons to recommend a contra-lateral side harvest in professional athletes. 7 In conclusion, unexpected complex fractures might be encountered in patients post ACL reconstruction due to the vulnerable bony structure following the procedure with the creation of stress raisers.…”