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A Rare Technical Complication Causing ACL Graft Failure: Aberrant Femoral Tunnel Trajectory and Posterolateral Corner Compromise: A Case Report.

In order to o reproduce normal joint kinematics of the knee following anterior cruciate ligament (ACL) injury, anatomic reconstruction has been advocated1-6. This can be achieved best by recreating the native ACL footprints. Matching the location of the intra-articular apertures of the femoral and tibial tunnels to the anatomic footprints of the native ACL has been reported to be accomplished most accurately with techniques other than traditional transtibial drilling7-11. In the pediatric population, the trajectory of the femoral tunnel is more heavily scrutinized because of its relationship to the distal femoral physis. However, in adults, clinical evidence is sparse regarding the appropriate tunnel trajectory. Cadaveric studies detailing the anatomic relationships of the femoral tunnel to the structures of the lateral aspect of the knee also have been reported12-16. The proximity of the lateral exit point of the femoral tunnel to critical lateral structures placed with an independent tunnel drilling technique has been shown to be a potential source of iatrogenic injury15. To our knowledge, there are no reports in the literature of injury to the posterolateral corner (PLC) as a result of femoral tunnel placement in ACL reconstruction. We present a case of PLC compromise and ACL graft failure following aberrant femoral tunnel placement in a revision ACL reconstruction. The patient was informed that data concerning the case would be submitted for publication, and he provided consent.

A twenty-one-year-old male intercollegiate football player presented after sustaining a knee injury while performing a lateral shuffling drill during an off-season workout. He had been treated by two different orthopaedists and had undergone two surgeries on the affected knee for treatment of ACL insufficiency prior to this most recent injury. Three years prior to presentation, he had ruptured his …