Proximal Tibial Fracture after Bone-Patellar Tendon-Bone Autograft Harvesting in Anterior Crutiate Ligament Reconstruction: Literature Review and Report of Two Cases

Abstract

ACL reconstruction surgery shows low incidence of complications (1.38%) like DVT, Infection, patellar tendon rupture and fractures whether in the proximal tibia or the distal femur. We hereby present two cases that have had the rare complication of proximal tibial fracture. The circumstances of each case are discussed together with discussion of similar cases described in the literature. We tried in the end to have an idea about the possible causes and how to prevent such a devastating event. Case presentation: Case 1 shows a 38-year-old female patient who had an ACL reconstruction surgery by BTB graft followed by iatrogenic proximal tibial fracture managed by open reduction internal fixation by T plate and screws. Case 2 shows a 28-year-old male patient who had an ACL reconstruction surgery by BTB graft also followed by Proximal tibial fracture 3 weeks later managed by open reduction internal fixation using a locked plate and screws. Discussion: Fractures are a rare complication that may follow ACL reconstruction surgery. These fractures can be femoral or tibial that may be due to the reduction of the bone strength as a result of the drill holes which behave as a stress riser. We also suggest that usage of osteotomes during grafting plays a role in these fractures. Management of these fractures is either by open reduction and internal fixation or closed reduction. What is known about the subject: Patellar fractures are a known complication of ACL reconstruction using patellar tendon graft. What this study adds to the existing knowledge: Raising the Knowledge that also the tibia can be fractured as a complication of patellar tendon harvesting not only the patella.