HSS Journal

, Volume 4, Issue 1, pp 20–24 | Cite as

Proximal Tibia Fracture After Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft: A Case Report

  • James E. Voos
  • Mark C. Drakos
  • Dean G. Lorich
  • Stephen Fealy


The optimal operative management of anterior cruciate ligament (ACL) injury continues to be debated. Many complications can occur, but fracture is often not routinely discussed. We present a complex intra-articular tibia fracture in a patient who had an autologous, ipsilateral bone-patellar-bone ACL reconstruction. While still advocating early, aggressive physical therapy, this case reminds us of the inherent susceptibility to injury in the immediate post-operative period.

Key words

ACL tibia fracture bone-patellar tendon-bone 


  1. 1.
    Freedman KB, D’Amato MJ, Nedeff DD, et al. (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11PubMedGoogle Scholar
  2. 2.
    Goldblatt JP, Fitzsimmons SE, Balk E, et al. (2005) Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy 21:791–803PubMedCrossRefGoogle Scholar
  3. 3.
    Noyes FR, Butler DL, Grood ES, et al. (1984) Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 66:344–352PubMedGoogle Scholar
  4. 4.
    Delcogliano A, Chiossi S, Caporaso A, et al. (2001) A tibial plateau fracture after arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 17:E16PubMedCrossRefGoogle Scholar
  5. 5.
    el-Hage ZM, Mohammed A, Griffiths D, et al. (1998) Tibial plateau fracture following allograft anterior cruciate ligament (ACL) reconstruction. Injury 29:73–74PubMedCrossRefGoogle Scholar
  6. 6.
    Mithofer K, Gill T, Vrahas M (2004) Tibial plateau fracture following anterior cruciate ligament reconstruction. Knee Surg Trauma 12:325–328Google Scholar
  7. 7.
    Moen KY, Boynton MD, Raasch WG (1998) Fracture of the proximal tibia after anterior cruciate ligament reconstruction: a case report. Am J Orthop 27:629–630PubMedGoogle Scholar
  8. 8.
    Morgan E, Steensen RN (1998) Traumatic proximal tibial fracture following anterior cruciate ligament reconstruction. Am J Knee Surg 11:193–194PubMedGoogle Scholar
  9. 9.
    Sundaram RO, Cohen D, Barton-Hanson N (2006) Tibial plateau fracture following gracilis-semitendinosus anterior cruciate ligament reconstruction: The tibial tunnel stress-riser. Knee 13:238–240PubMedCrossRefGoogle Scholar
  10. 10.
    Thaunat M, Nourissat G, Gaudin P, et al. (2006) Tibial plateau fracture after anterior cruciate ligament reconstruction: Role of the interference screw resorption in the stress riser effect. Knee 13:241–243PubMedCrossRefGoogle Scholar
  11. 11.
    Wilson TC, Rosenblum WJ, Johnson DL (2004) Fracture of the femoral tunnel after an anterior cruciate ligament reconstruction. Arthroscopy 20:e45–e47PubMedCrossRefGoogle Scholar
  12. 12.
    Johnson BA, Fallat LM (1997) The effect of screw holes on bone strength. J Foot Ankle Surg 36:446–451PubMedCrossRefGoogle Scholar
  13. 13.
    Ito MM, Tanaka S (2006) Evaluation of tibial bone-tunnel changes with x-ray and computed tomography after ACL reconstruction using a bone-patella tendon-bone autograft. Int Orthop 30:99–103PubMedCrossRefGoogle Scholar
  14. 14.
    Small NC (1988) Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy 4:215–221PubMedCrossRefGoogle Scholar
  15. 15.
    Yu JK, Paessler HH (2005) Relationship between tunnel widening and different rehabilitation procedures after anterior cruciate ligament reconstruction with quadrupled hamstring tendons. Chin Med J 118:320–326PubMedGoogle Scholar
  16. 16.
    Clark CR, Morgan C, Sonstegard DA, et al. (1977) The effect of biopsy-hole shape and size on bone strength. J Bone Joint Surg Am 59:213–217PubMedGoogle Scholar
  17. 17.
    Fauno P, Kaalund S (2005) Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 21:1337–1341PubMedCrossRefGoogle Scholar
  18. 18.
    Mosca JC, Cahill JB, Tucker CY (2006) Postsurgical rehabilitation guidelines for the orthopedic clinician. Mosby, Saint Louis, MO, pp 425–438Google Scholar
  19. 19.
    Heier KA, Mack DR, Moseley JB, Paine R, Bocell JR (1997) An analysis of anterior cruciate ligament reconstruction in middle-aged patients. Am J Sports Med 25(4):527–532PubMedCrossRefGoogle Scholar
  20. 20.
    Plancher KD, Steadman JR, Briggs KK, Hutton KS (1998) Reconstruction of the anterior cruciate ligament in patients who are at least forty years old. J Bone Joint Surg 80–A2:184–197Google Scholar
  21. 21.
    Marquass B, Hepp P, Engel T, Dusing T, Lill H, Josten C (2007) The use of hamstrings in anterior cruciate ligament reconstruction in patients over 40 years. Arch Orthop Traum Surg Apr 14; [Epub ahead of print]Google Scholar
  22. 22.
    Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE (2005) Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med 33(10):1579–1602, OctPubMedCrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2007

Authors and Affiliations

  • James E. Voos
    • 1
  • Mark C. Drakos
    • 1
  • Dean G. Lorich
    • 2
  • Stephen Fealy
    • 1
  1. 1.Department of Sports MedicineThe Hospital for Special SurgeryNew YorkUSA
  2. 2.Orthopedic Trauma ServiceThe Hospital for Special SurgeryNew YorkUSA

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