Technique for Treatment of Subchondral Compression Fracture of the Lateral Femoral Condyle Associated With ACL Tear

Excessive knee pivoting that causes a complete anterior cruciate ligament (ACL) tear may result in a subchondral compression fracture on the lateral femoral condyle after impacting the lateral tibial condyle. Because this mechanism is similar to the humeral head that has an impact on the glenoid during an anterior shoulder dislocation, such an osteochondral fracture can be considered equivalent to a “Hill-Sachs lesion of the knee.” Restoring the native anatomy of the lateral femoral condyle articular surface is crucial, because its depression alters knee biomechanics, leading to bony knee instability, potentially greatly elevating the risk of ACL reconstruction failure and meniscal tears. In addition, bony knee instability increases the forces acting on the cartilage, which may impair one's quality of life and lead to the development of osteoarthritis. The fact that many patients with complete ACL tears are relatively young emphasizes the key role of osteoarthritis prevention. The aim of this report is to present a minimally invasive procedure to treat the “Hill-Sachs–like” knee lesion, a tricky enemy of knee stability.