Two-staged arthroscopy-assisted treatment of a large depression fracture in the lateral femoral condyle associated with an acute anterior cruciate ligament tear

A 38-year-old man sustained a large depression fracture in the lateral femoral condyle associated with an acute anterior cruciate ligament (ACL) tear in the right knee, while snowboarding. Ten days after the injury, we started a two-staged operation plan. Because the depressed area in the lateral femoral condyle was very huge, we performed an arthroscopically assisted reduction of the depression fracture in the first operation. Under arthroscopic observations, we created a bone tunnel from the extra-articular wall of the lateral condyle towards the depressed subchondral area and anatomically reduced the subchondral bone using a bone impactor. Then, we grafted many cancellous bone chips harvested from the iliac crest. The computed tomography (CT) showed that the regular, convex shape of the lateral femoral condyle was almost restored. Postoperatively, we did not perform aggressive rehabilitation. CT taken at 12 weeks showed that the small impressed lesion of the lateral femoral condyle surface existed in a part of the area almost anatomically reduced in the first surgery. At 13 weeks after the first surgery, we carried out the second operation, which included anatomic double-bundle ACL reconstruction with the semitendinosus tendon and an additional osteochondral plug graft for the small defect using an 8-mm osteochondral plug. At 2 years after the second operation, the patient returned to his previous level of snowboard activity without any knee pain. The Lachman test was found to be negative, and a range of knee motion was between 0 and 130°.