Breakage of the Femoral Cross-Pin with Impending Rupture of the Popliteal Vessels after Anterior Cruciate Ligament Reconstruction

Lih Wang; Kyung Taek Kim; Won Seok Park; Sung Yoon Jung; Young Hun Jung

doi:10.4055/jkoa.2016.51.4.350

Journal List > J Korean Orthop Assoc > v.51(4) > 1013465

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Wang, Kim, Park, Jung, and Jung: Breakage of the Femoral Cross-Pin with Impending Rupture of the Popliteal Vessels after Anterior Cruciate Ligament Reconstruction

Case Report

Journal of the Korean Orthopaedic Association 2016; 51(4): 350-355.

Published online: 11 August 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.4.350

Breakage of the Femoral Cross-Pin with Impending Rupture of the Popliteal Vessels after Anterior Cruciate Ligament Reconstruction

Lih Wang, M.D., Ph.D., Kyung Taek Kim, M.D.^*, Won Seok Park, M.D.^*, Sung Yoon Jung, M.D., Young Hun Jung, M.D.

Department of Orthopaedic Surgery, Dong-A University College of Medicine, Busan, Korea.

^*Department of Orthopaedic Surgery, Dong-Eui Medical Center, Busan, Korea.

Correspondence to: Lih Wang, M.D., Ph.D. Department of Orthopaedic Surgery, Dong-A University College of Medicine, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Korea. TEL: +82-51-240-2593, FAX: +82-51-254-6757, libi33@dau.ac.kr

Received 17 November 2015 Revised 11 January 2016 Accepted 11 January 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Breakage of the femoral cross-pin with impending rupture of the popliteal vessels is a rare complication for femoral tunneling in anterior cruciate ligament (ACL) reconstruction. The authors experienced a case of impending rupture of the popliteal vessels following breakage of the cross-pin 16 days after primary ACL reconstruction. Impending rupture of the popliteal vessels was detected with ultrasonography following breakage of the cross-pins which caused popliteal discomfort and irritation. After removal of the broken cross-pins, previous ACL graft and interference screw with subsequent re-reconstruction of the ACL using a new allograft and interference screw, the patient showed satisfactory results and resolution of symptoms. Therefore we report on this case with a review of literature.

Keywords: anterior cruciate ligament, cross-pin, popliteal vessels, breakage, impending rupture

Figures and Tables

Figure 1

Magnetic resonance imaging showed that the reconstructed anterior cruciate ligament was intact but the femoral cross-pin had penetrated into the popliteal area. (A) T1 sagittal image. (B) T2 coronal image.

Figure 2

Serial computed tomographic axial images of the distal femur showed that the femoral tunnel was involved with a blown out posterior cortical rim and that the femoral cross-pin protruded into the popliteal area in a posteromedial direction.

Figure 3

Ultrasonographic image showed that the cross-pin was nearly in contact with the popliteal artery but not penetrated (white arrows: popliteal artery, white arrow heads: cross pin).

Figure 4

(A) Intraoperative arthroscopic image showing a remnant broken piece of the cross-pin after removal of the initial anterior cruciate ligament graft. (B) Clinical photograph showing the 2 removed cross-pins. One cross-pin was broken and the broken piece was retrieved from the joint cavity through arthroscopy.

Notes

This study was supported by research funds from Dong-A University.

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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