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Femoral Condylar Fracture Through a Femoral Tunnel Eleven Years After Anterior Cruciate Ligament ReconstructionA Case Report
Terrill P. Julien, MD1; Arun J. Ramappa, MD1; Edward K. Rodriguez, MD, PhD1
1 Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215. E-mail address for E.K. Rodriguez: ekrodrig@BIDMC.Harvard.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Apr 01;92(4):963-967. doi: 10.2106/JBJS.I.00408
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Anterior cruciate ligament reconstruction is among the most commonly performed orthopaedic procedures in the United States, with more than 100,000 done each year1. Complication rates associated with this procedure range between 1.8% and 24%, with the most common problem being joint stiffness2. Infection, reflex sympathetic dystrophy, hardware failure, and fracture are also known to occur. Fracture of the patella is the most common fracture in the postoperative period, but supracondylar fractures have also been reported2-5. Fracture through the femoral tunnel is a rare but increasingly documented complication of arthroscopic reconstruction of the anterior cruciate ligament2-5. A number of authors have reported interference screws and multiple trocar pin holes acting as stress risers predisposing to femoral fracture, and fractures through screw-hole-augmentation devices have been reported as well2-5. Two recent case reports also describe supracondylar stress fractures developing in professional athletes who may have returned to competitive sports too early (at twenty-two and twelve weeks after the surgery)3,5. Here, we report a femoral condylar fracture through an accessory lateral femoral tunnel used for cross-pinning femoral graft fixation in an anterior cruciate ligament reconstruction performed eleven years previously. To our knowledge, other reported cases of femoral fracture following anterior cruciate ligament reconstruction have all been through the primary femoral graft tunnel site. The patient was informed that data concerning the case would be submitted for publication, and he consented.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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