Case report
Arthroscopically Assisted Reduction of a Lateral Femoral Notch in Acute Tear of the Anterior Cruciate Ligament

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Abstract

We report the case of a 20-year-old soccer player who suffered a tear of the anterior cruciate ligament with a depression fracture of the lateral femoral condyle. In addition to repairing the ligament we were able to arthroscopically reduce the depression fracture using a bioabsorbable screw. We tamped the surrounding cancellous bone with dilatators and chisels to create a bearing for an interference screw. This prepared for the placing of the screw and resulted in a sufficient reshaping of the condyle. We then inserted a threaded bioabsorbable interference screw into the lateral condyle under arthroscopic guidance to reline the fracture and reduce joint incongruity. Postoperative magnetic resonance imaging showed a significant reduction of the fracture.

Section snippets

Case report

A 20-year-old male college student injured his left knee while playing soccer. The patient reported twisting his knee and being tackled by an opponent while retaining this position. This led to an audible popping sound from the joint followed by swelling and pain; later, subjective instability ensued. Three days later, he underwent arthroscopic surgery at a local hospital where a tear of the ACL with a concomitant impaction fracture of the lateral condyle was diagnosed. Additional MRI confirmed

Discussion

This case exemplifies the possibility to treat a lateral femoral depression fracture or “lateral notch” associated with an acute ACL tear via a minimal surgical approach with good results. Subchondral edema of the lateral condyle is a frequent finding on MRI after acute ACL injury,4 and sometimes a depression fracture in this area ensues. It has been attributed to chronic instability in the past by some authors.3, 7 This might lead to neglecting the necessity to reduce such a fracture, and

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Cited by (17)

  • Fate of the lateral femoral notch following early anterior cruciate ligament reconstruction

    2020, Knee
    Citation Excerpt :

    However, not only deformation, but also higher cartilage degeneration is assumed due to altered MRI relaxation times one year post-injury [12]. Treatment options with either arthroscopic or open reduction have been described in a limited number of cases [13–15], although, the long-term consequences and evidence-based indications for operative treatment of a lateral femoral notch (LFN) are still unknown. The main goal of this longitudinal study was to evaluate the long-term development of the LFN including depth, volume and area of the defect.

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Cite this article as: Sadlo PA, Nebelung W. Arthroscopically assisted reduction of a lateral femoral notch in acute tear of the anterior cruciate ligament. Arthroscopy 2006;22:574.e1-574.e3 [doi:10.1016/j.arthro.2005.11.006].

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