Fracture of the proximal extremity of the tibia after anterior cruciate ligament reconstruction: case report

Abstract

We report a rare condition that has been little described in the literature: a fracture of the proximal extremity of the tibia after anterior cruciate ligament reconstruction using an autologous patellar bone-tendon graft. In this report, we discuss the factors that predisposed toward this episode, the treatment and the evolution of the case after the surgical treatment.

Uncommon Complications after Anterior Cruciate Ligament Reconstruction

“…29 42 Furthermore, other authors reported an increased risk of tibial fracture if a BPTB graft was used, probably due to the increased stress related to both presence of a tibial defect (for graft harvesting) and the tibial tunnel. 43 There are 17 case reports in literature describing tibial fracture after ACL-R. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 However, five case reports were excluded from this review because the fracture was due to a high energy trauma (traffic accident). 51 52 53 54 55 Furthermore, one case report was excluded because it was written in German language 56 and one other because it was poorly described.…”

“…The patients underwent conservative treatment in a long leg cast and completely recovered from the complication. 50 In the remaining nine reports, the BPTB graft was used in five cases, 43 45 46 47 while soft tissue graft was used in four cases. 10 48 49 58 In most of the cases the fracture occurred within 6 months from the ACL-R. 44 58 However, in one case it occurred 4.5 years after surgery due to a minor trauma in a 40 years old man.…”

“…10 Fractures occurred at the tibial tunnel in three cases 10 48 49 and at the harvesting site in four cases. 44 45 46 58 In one case, the fracture begun from the transosseous tunnel and involved the entire tibial plateau. 43 In the remaining case, the fracture occurred at the graft fixation site at the tibial side.…”

“…47 All patients presented complaining about swelling, hemarthrosis, and inability to bear weight. In seven cases, the fracture was diagnosed with an X-ray 43 44 45 46 48 58 and in seven cases, a computed tomography (CT) scan was obtained to better evaluate fracture morphology 43 44 45 47 48 58 . In one case the undisplaced tibial plateau fracture was not detected with X-rays and an MRI was necessary to confirm the diagnosis.…”

“…In one case the undisplaced tibial plateau fracture was not detected with X-rays and an MRI was necessary to confirm the diagnosis. 49 Three cases were surgically managed with open reduction and internal fixation, 10 45 46 one case was surgically treated with a minimally invasive surgical technique using screws. 43 In all these cases the fracture was displaced.…”