J Korean Orthop Assoc.  2016 Aug;51(4):350-355. 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

• Wang L
• Kim KT
• Park WS
• Jung SY
• Jung YH

• KMID: 2348643
• DOI: http://doi.org/10.4055/jkoa.2016.51.4.350

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.

Keyword

anterior cruciate ligament; cross-pin; popliteal vessels; breakage; impending rupture

MeSH Terms

Allografts
Anterior Cruciate Ligament Reconstruction*
Anterior Cruciate Ligament*
Humans
Rupture*
Transplants
Ultrasonography

Figure

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  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.

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  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.

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  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).

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  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.

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