Late Hoffa fracture of the lateral femoral condyle in an ACL reconstructed knee

A 33-year-old male sustained Hoffa fracture of the lateral femoral condyle 10 months after arthroscopic reconstruction of the anterior cruciate ligament in the same knee. The ligament had been reconstructed with autologous, quadrupled hamstring graft and was anchored in the femoral tunnel with a cortical suspensory device. As the fracture line did not involve the femoral tunnel, the ACL graft was spared, and the fracture was managed by open reduction and internal fixation. Fracture union was achieved by 6 months and the patient recovered uneventfully. At the 5- year follow-up, the patient had a stable pain-free knee. This case report highlights the possibility of late lateral femoral condyle Hoffa fracture treatment via arthroscopic ACL reconstruction without extra-articular tenodesis and despite taking adequate intra-operative precautions during tunnel drilling and using a cortical suspensory device for anchoring the graft on the femoral side.