Peri-anterior cruciate ligament reconstruction femur fracture: a biomechanical analysis of the femoral tunnel as a stress riser

Han, Yung; Sardar, Zeeshan M.; McGrail, Scott; Steffen, Thomas; Martineau, Paul A.

doi:10.1007/s00167-011-1527-8

Cited by 19 publications

(18 citation statements)

References 58 publications

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“…After anterior cruciate ligament reconstruction acute fractures usually, but not always occur through the drilled canals [ 19 , 20 ]. In an investigation of composite femur bones, all specimens failed through the femoral canals of the double-bundle ACL reconstruction technique, but in the single bundle technique the fracture patterns were similar to the intact groups and only half occurred through the drill canal [ 21 ]. In a similar study of tibial fractures, it was found that load to failure was similar in all groups (intact, single bundle and double bundle reconstructions) [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Drill holes decrease cancellous bone strength: A comparative study of 33 paired osteoporotic human and 9 paired artificial bone samples

et al. 2020

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This study was designed to compare compressive strength of cancellous bone retrieved from the femoral head in a specimen with and without guide wire hole, with comparison to synthetic bone samples. Femoral heads retrieved from 33 patients who sustained femoral neck fractures and underwent hip arthroplasty were cut into cuboids leaving two matching samples from the same femoral head. Similar samples were prepared from synthetic femurs. One of the matching samples was chosen at random and was drilled with a guide wire for cancellous screws. The uniaxial compression tests of bone blocks were carried out using the Zwick-Roell Z020 strength testing machine. The mean loss of sample cross section area due to drilling was 24%. The force at failure in drilled specimens was significantly smaller by 18% in human (median: 26%) and by 25% in synthetic bone (median 27%). The strength of human specimens was almost 2 times greater, and their stiffness nearly 4 times greater than in synthetic samples. The study shows that the weakening of the bone after drilling is roughly proportional to the loss of sample cross section area. The percentage decrease in strength was similar in human and artificial bone, but human samples were stronger and stiffer. The comparison shows that forces measured in biomechanical studies on artificial bone cannot be directly attributed to humans, but the relative differences in mechanical properties of synthetic samples after some damage may be accurate and resemble that of human bones.

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Section: Discussionmentioning

confidence: 99%

Drill holes decrease cancellous bone strength: A comparative study of 33 paired osteoporotic human and 9 paired artificial bone samples

et al. 2020

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“…The anatomical double-bundle reconstruction provides more space for the posterior wall compared to the single-bundle technique, allowing graft placement in a horizontal plane. Although several studies have reported that the risk of femoral condyle fracture is higher in double-tunnel reconstruction [16] [17], using biomechanical and computerized models, Smolinski et al showed that the risk of fracture increased comparably in both methods [18]. To prevent merging, the femoral and tibial tunnels should be opened divergent rather than on the same axis, and soft tissues in the tibial footprint and notch should be removed to obtain a clear view.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Results of Double-Bundle Anterior Cruciate Ligament Reconstruction and Technique-Specific Problems

Güler¹,

Donmez²,

Mahiroğulları³

et al. 2014

OJO

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Background: In this study, we determined the efficiency of anterior cruciate ligament (ACL) reconstruction using the double-bundle technique and addressed technique-specific problems. Patients and Methods: Twenty-nine patients who underwent ACL reconstruction due to ACL rupture with the arthroscopic double-bundle ENDOBUTTON CL method using autogenous hamstring tendons were evaluated. All patients were males and the mean age was 24.3 years (range 20-41 years). The mean follow-up period was 36.4 months (minimum 16 and maximum 53 months). Diagnosis was based on medical history and physical examination. Lachman, anterior drawer and pivot shift tests were performed. The patient diagnosis was verified with X-ray roentgenogram and magnetic resonance imaging (MRI). Tunnel mergence and graft hanging problems were discussed. Results: Pre-and postoperative clinical assessments of the patients showed the mean Lysholm score increased from 60.2 (48-72) preoperatively to 91.5 (85-98) at the final visit, whereas the mean Tegner score increased from 5.58 (3-9) preoperatively to 6.03 (4-9) at the final visit. According to the International Knee Documentation Committee (IKDC) knee ligament standard evaluation system, five patients were classified as B (17%); 11 patients were classified as C (38%); and 13 patients were classified as D (45%) before the surgery. At the postoperative evaluation, 17 (59%) patients were classified as A; 11 (38%) patients were classified as B; and 1 (3%) patient was classified as C. Conclusion: The double-bundle technique using hamstring tendons and femoral * Corresponding author. O. Guler et al. 206 braces is an efficient and satisfactory method for ACL reconstruction.

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“…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.…”

Section: Rare Fracturesmentioning

confidence: 99%

“…Furthermore, the fracture patterns of the DB group always occurred through both femoral tunnels at the notch, whereas the SB groups had similar fracture patterns throughout the lateral cortex and not always involving the femoral tunnel. 59 Although the incidence of femoral fracture due to ACL-R is unknown, it is suspected to be extremely low. 73 There were 13 case reports of femoral fractures after ACL-R in literature including 14 patients.…”

Section: Rare Fracturesmentioning

confidence: 99%

Uncommon Complications after Anterior Cruciate Ligament Reconstruction

Palazzolo

Rosso

Bonasia

et al. 2018

Joints

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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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Peri-anterior cruciate ligament reconstruction femur fracture: a biomechanical analysis of the femoral tunnel as a stress riser

Cited by 19 publications

References 58 publications

Drill holes decrease cancellous bone strength: A comparative study of 33 paired osteoporotic human and 9 paired artificial bone samples

Drill holes decrease cancellous bone strength: A comparative study of 33 paired osteoporotic human and 9 paired artificial bone samples

Preliminary Results of Double-Bundle Anterior Cruciate Ligament Reconstruction and Technique-Specific Problems

Uncommon Complications after Anterior Cruciate Ligament Reconstruction

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