An unusual periarticular fracture following ipsilateral anterior cruciate ligament reconstruction

We report an unusual pattern of a peri and intra-articular knee fracture following ACL reconstruction. The pattern of injury was opposite to the graft tunnels which contradicts the well established iatrogenic stress riser theory which has been extensively described in the literature. The fractures were reduced anatomically by open means, the graft was found intact and preserved and the fractures were fixed internally protecting the graft and the tunnels. The patient made an uneventful recovery and the post operative MRI scan 12 months later demonstrated bone healing and an intact ACL. When the ACL graft is found intact in this type of injury, the fracture should be fixed around it taking care not to jeopardize its integrity or the tunnels.