Bilateral Medial Tibial Plateau Fracture after Arthroscopic Anterior Cruciate Ligament Reconstruction

Abstract

Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures.

Keywords: Anterior cruciate ligament; Arthroscopic reconstruction; Tibial plateau fracture.

Fig. 1. Preoperative anteroposterior (A) and lateral (B) radiographs of the right knee and anteroposterior (C) and lateral (D) radiographs of the left knee showing tibial plateau fractures involving medial condyles. Coronal (E) and axial (F) computed tomography (CT) scans of the right knee and coronal (G) and axial (H) CT scans of the left knee showing evidence of intra-articular tibial plateau fractures involving medial condyles. There are thin fracture lines extending to tibial tunnels.

Fig. 2. Second-look arthroscopy of the right knee (A) and left knee (B) showing intact anterior cruciate ligaments.

Fig. 3. Anteroposterior (A) and lateral (B) radiographs of the right knee and anteroposterior (C) and lateral (D) radiographs of the left knee showing healed fractures at 5 months follow-up.