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A Rare Technical Complication Causing ACL Graft Failure: Aberrant Femoral Tunnel Trajectory and Posterolateral Corner CompromiseA Case Report
William R. Mook, MD1; William E. Garrett, Jr., MD, PhD1
1 Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000 (W.R.M.), Box 3338 (W.E.G), Durham, NC 27710. E-mail address for W.R. Mook: william.mook@duke.edu. E-mail address for W.E. Garrett Jr.: william.garrett@duke.edu
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Investigation performed at the Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jul 24;3(3):e73 1-4. doi: 10.2106/JBJS.CC.M.00007
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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.
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