Highlights
- •Avulsion fracture of the intercondylar eminence can occur during Oxford UKA surgery.
- •Special care should be taken if the extension is tight and/or the horizontal cut is excessive.
- •Having a cannulated cancellous screw at hand advisable, and attention should be paid to the postoperative limit of extension.
Abstract
Background
Unicompartmental knee arthroplasty (UKA) can provide good postoperative results and
long term survival, but there may be complications. We present a rare case of avulsion
fracture of the intercondylar eminence during UKA surgery.
Case presentation
An 88-year-old man had right-knee pain with anteromedial osteoarthritis. Oxford partial
knee UKA (Zimmer Biomet, Warsaw, IN) was performed by the senior author by the under-vastus
approach using Microplasty instruments. During the final check of the range of motion,
an avulsion fracture of the intercondylar eminence occurred at the terminal extension.
A 4.0 mm cannulated cancellous screw was inserted into the intercondylar eminence
from just in front of the anterior cruciate ligament to the posterior tibial cortex.
Six months postoperatively, bony fusion was confirmed by lateral radiography. Two
years after the surgery, the patient was fully satisfied. The flexion angle was 125°,
but still with an extension limit of 10°.
Discussion
Avulsion fracture of the intercondylar eminence can be caused by hyperextension and/or
the ACL becoming tighter in full extension of the knee. In this patient, avulsion
fracture also probably occurred due to increased tension of the ACL in the fully extended
position. After making the horizontal cut, we inserted a thin metal plate to prevent
deeper vertical cuts, but an excessive horizontal cut was a possible cause of the
fracture. As treatment for avulsion fracture of the intercondylar eminence, fixation
of the cannulated cancellous screw resulted in uneventful bone fusion. We recommend
having a cannulated cancellous screw at hand for such complications and for other
potential intraoperative problems, such as tibial plateau fracture. Further investigation
into limited postoperative extension might be needed.
Conclusion
Our patient had intraoperative avulsion fracture of the intercondylar eminence, a
relatively rare complication of Oxford UKA which is probably caused by the extension
being tight and/or an excessive horizontal cut. Having a cannulated cancellous screw
at hand is advised, and attention should be paid to postoperative limit of extension.
Keywords
Abbreviations:
ACL (anterior cruciate ligament), BCR-TKA (bi-cruciate retaining total knee arthroplasty), OKS (Oxford knee score), TKA (total knee arthroplasty), UKA (unicompartmental knee arthroplasty)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 10, 2022
Accepted:
November 14,
2022
Received in revised form:
September 29,
2022
Received:
May 25,
2021
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
