KNEE Intra-articular lateral femoral condyle fracture following an ACL revision reconstruction Benjamin R. Coobs • Stanislav I. Spiridonov • Robert F. LaPrade Received: 17 September 2009 / Accepted: 6 November 2009 Ó Springer-Verlag 2009 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. Keywords Anterior cruciate ligament Á Lateral femoral condyle fracture Á Revision reconstruction Introduction Anterior cruciate ligament (ACL) reconstruction is a common procedure among young and active patients. However, a small subset of patients may have surgical complications such as fractures of the patella, patellar tendon rupture, loss of motion, and hardware failure, which can significantly affect their outcomes [7]. Lateral femoral condyle fracture is a rare complication of primary ACL reconstruction [1, 2, 6, 8, 10] through drill holes that may have served as stress concentrators and reduced the energy absorbing capacity of the bone [3]. No cases of lateral femoral condyle fracture following a revision ACL reconstruction were found in the literature. This case report presents a complex fracture of the lateral femoral condyle following an ACL revision reconstruction. Case report A 33-year-old healthy Caucasian male was referred to our tertiary care center for evaluation and treatment of a lateral femoral condyle fracture that occurred approximately 3 weeks after undergoing a left ACL revision reconstruc- tion at an outside institution. Six years previously, the patient had an index one incision endoscopic left knee ACL reconstruction using a bone–patellar tendon–bone allograft and a partial medial and lateral meniscectomy after sus- taining an ACL tear. He reported that his graft never functioned well, and he had continued instability through- out these 6 years. Therefore, he underwent a two incision revision ACL reconstruction using an autogenous bone– patellar tendon–bone graft placed into a separate femoral tunnel than the original one incision ACL reconstruction. He initiated a postoperative rehabilitation program, which additionally included physical therapy for low back pain. Three weeks following his revision ACL reconstruction, he underwent a manipulation of his left SI joint that involved axial distraction of his left lower extremity. Immediately following the manipulation, the patient experienced sig- nificant left knee pain and swelling. A left knee MRI scan showed an intra-articular lateral femoral condyle fracture. He was placed into a knee immobilizer and referred to our center for further treatment. His initial physical examination, 6 weeks following his revision ACL reconstruction, revealed a 2? left knee effusion and significant tenderness along the lateral joint line. Passive knee flexion resulted in significant pain, with limited motion from 30° to 75°. Lachman, posterior drawer, varus, and valgus stress were not evaluated secondary to pain. Radiographs demonstrated a displaced lateral femoral condyle fracture. A thin slice CT scan was also obtained to B. R. Coobs Á S. I. Spiridonov Á R. F. LaPrade (&) Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave, R-200, Minneapolis, MN 55454, USA e-mail: lapra001@umn.edu 123 Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-009-0995-6