Supracondylar femur fracture after endoscopic anterior cruciate reconstruction using an EndoButton.

Surgical reconstruction of the anterior cruciate ligamentdeficient knee has become very common, with the majority of reconstructions performed using the semitendinosusgracilis tendon autograft construct or the central third bonepatellar tendon-bone autograft construct. Although generally uncommon, complications after anterior cruciate ligament reconstruction occur, and may include fractures of the distal femur, proximal tibia, or distal patella. The case described below is the seventh femur fracture reported after ACL reconstruction, and the first associated with the use of an EndoButton (Smith + Nephew, Andover, MA) for femoral fixation. The fracture was felt to result from a lower than expected level of energy, on the basis of the patient’s age, health, and bone quality, and was likely due to a stress riser created from multiple perforations through the anterolateral cortex of the femur from the femoral guide pin, in addition to the EndoButton tunnel.