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Case reports

hpry Vol. 39, No. 1, pp. 73-74, 1998 8 1998 Published by Elsevier Science Ltd. All rights reserved

Printed in Great Britain 0020-1383/98 $19.00 + 0.00

Tibia1 plateau fracture following allograft anterior cruciate ligament (AU) reconstruction

Ziad M. EL-Hage, Aslam Mohammed, David Griffiths and James B. Richardson The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK

Injury, Vol. 29, No. 1, 73-74, 1998

A 20-year-old male presented with a painful, swollen right knee following a road traffic accident. Plain radiographs revealed a fracture of the medial tibia1 plateau. Eighteen months before the accident, an arthroscopic anterior cruciate ligament (ACL) recon- struction with a freeze-dried Achilles tendon allograft had been performed on his injured knee. The allograft was secured at both ends with Richards interference screws (Smith & Nephew).

The CT scan demonstrated a fracture passing through the proximal part of the tibia1 tunnel with a small posteromedial fragment (Figure 2). Examination under anaesthesia revealed negative Lachmann, anterior drawer and pivot-shift tests. Arthroscopic examination revealed an intact ACL and confirmed an intra-articular fracture of the tibia1 plateau through the tibia1 tunnel. A biopsy of the allograft was performed during this procedure. Open reduc- tion and internal fixation of the tibia1 plateau fracture was performed using an anteromedial approach. Histopathology identified collagenous tissue containing viable fibrocytes and scattered blood vessels.

The patient made an uneventful postoperative recovery and was discharged 10 days after operation. At 7 months follow-up, he had full range of movement and had resumed his normal recreational activities.

Discussion ACL reconstruction is increasingly popular world- wide with the higher demands of both professional and recreational athletes.

Major complications of ACL reconstruction are rare, only a few have been reported so far. These include patella tendon rupture’, patella fracture’, donor site pain’, patella tendon tendonitis’ and avascular necrosis of the femoral condyles’. In

Figure 1.

addition, osteolysis around the graft has been reported particularly with the use of Gortex ligaments and allografts”.

In this patient there was no osteolysis of the tibia1 nor of the femoral tunnel and the allograft appeared viable 18 months after ACL reconstruction.

The allograft comprises irradiated frozen cadaver material that has been shown to be as strong before irradiatioin. Frozen graft is used in preference to freeze-dried allograft’,‘.

The presence of the tunnel could be the main factor in predisposing this patient to this type of fracture as it may have acted as a stress riser. The authors are not aware of any previous case reports describing a fracture through the tibia1 tunnel following allograft reconstruction of the anterior cruciate ligament.

References 1 Strover, A. E., Zntrn-orticulnr Xrconstruction of the Atlterior

Crucinte L@rme~~t. Butterworth-Heinemann, Oxford, 1993.

74 Injury: International Journal of the Care of the Injured Vol. 29, No. 1,199s

2 Christen l B. and Jakob R.P. Fractures associated with patellar tendon grafts in cruciate liagment surgery. I Butte joint Sq 1992; 748: 617-619.

3 Athanasian E.A., Wickiewilz T.L. and Warren R.F. Osteo-

5 Smith, C.W., Young, I. and Kearney, J.N., Mechanical properties of Tendons: Changes with sterilization and preservation. 1 Biomrch 1996; 118: 56-61.

necrosis of the femoral condyle after arthroscopic recon- struction of a cruciate liagment. ] Borze Joint Surg 1995;

Paper accepted 12 July 1997.

77A: 1418-1422. 4 Linn R.M., Fischer D.A., Smith J.P. et al. Achilles tendon

allograft reconstruction of the anterior cruciate liagment- deficient knee. Am J Spurts Med 1993; 21: 825-831.

Requests for reyrints should be addressed to: Professor James Richardson, The Robert Jones and Agnes Hunt Ortho- paedic Hospital, Oswestry, Shropshire SYlO 7AG, UK.