Lateral Condyle Impaction Fracture Reduction With Anterior Cruciate Ligament Reconstruction, Medial Collateral Ligament Reconstruction, and Repair of Lateral Meniscus Radial Tear After a High-Grade Pivot-Shift Injury

Authors:

Luke V. Tollefson B.S., Evan P. Shoemaker B.A., Nathan J. Jacobson M.D., Erik L. Slette M.D., Robert F. LaPrade M.D., Ph.D.

Abstract:

The pivot shift is a common injury mechanism during an anterior cruciate ligament injury in which the tibia rotates anterolaterally with a combined valgus force. This mechanism can lead to bone bruising and even impaction fractures of the lateral femoral condyle. High-grade pivot-shift cases can also lead to pinching of the lateral meniscus, causing tearing. In cases with a sufficient valgus force, combined injuries, including the medial collateral ligament, can also occur. This video technique describes the reconstruction of the anterior cruciate ligament and medial collateral ligament, lateral meniscus radial tear repair, and reduction of a lateral femoral condyle impaction fracture caused by a high-grade pivot-shift injury.

Video credit:Luke V. Tollefson B.S., Evan P. Shoemaker B.A., Nathan J. Jacobson M.D., Erik L. Slette M.D., Robert F. LaPrade M.D., Ph.D.
Published in: Arthroscopy Techniques, May 10, 2025

Abstract Continues:

One of the common injury mechanisms for an anterior cruciate ligament (ACL) tear is the pivot-shift mechanism, in which the tibia subluxes anterolaterally with a combined valgus force.1 This pivot-shift mechanism can result in bone bruising of the lateral femoral condyle (LFC) and posterior tibial plateau, with impaction fractures potentially occurring in high-grade cases.1, 2, 3 A previous study by Bernholt et al.2 described these impaction fractures on magnetic resonance imaging (MRI) and reported that for patients with primary ACL tears, 25.9% of patients had LFC impaction fractures.

During the pivot-shift mechanism, a large enough valgus force, combined with the anterolateral subluxation of the tibia, can pinch the lateral meniscus and cause tearing.2,4 The valgus force can lead to combined ACL and medial collateral ligament (MCL) tears, which are one of the most common injury patterns for multiligament knee injuries.5, 6, 7 In cases of high-grade MCL tears with significant medial compartment gapping, MCL reconstruction should be favored over nonoperative treatment.8,9 Additionally, radial tears should be repaired to mitigate the progression of osteoarthritis.10,11 In this Technical Note, we describe the surgical treatment for an ACL tear, an MCL tear, a lateral meniscus radial tear, and an LFC impaction fracture caused by a severe pivot-shift injury mechanism.

You can download the study here: Lateral Condyle Impaction Fracture Reduction With Anterior Cruciate Ligament Reconstruction, Medial Collateral Ligament Reconstruction, and Repair of Lateral Meniscus Radial Tear After a High-Grade Pivot-Shift Injury

Robert LaPrade, MD PhD

Average rating:

27 reviews

Michael freimuth

Aug 1, 2021

by Michael freimuth on Robert LaPrade, MD PhD

So lucky

In 2007 i was playing soccer and as i planted my left foot the goalie kicked my left knee dislocating it 90° to the left. I was told i tore everything...mcl pcl lcl acl all tendons around my knee the minicus flipped over the knee cap tearing the patellar tendon and oh yeah i guess i broke my femur too. First surgeon i went to literally gave me 2 options.
1) he could remove part of my leg because he couldnt find a pulse in my foot
2) he would refer me to the expert.
Obviously i chose the second option. Upon meeting his team, my life changed. There was never any talk of removing my leg and immediately found a pulse in my foot. On top of that they asked if i was free the coming Wednesday to operate. Hearing reviews about the U of M and of dr laPrade i went ahead and let him try to help me. Best decision ever. Yes, it took a long time to recover. But as i was healing he would find ways to help me be able to see him. Even said my left knee was tighter than my right. I had to have my meniscus removed during my surgery and after 2 years i still didn't have arthritis. It is now 2021, yes thats 14 years after my injury havent seen or spoken to him in 12 years.what he doesn't know.....
I did manual labor the whole time grueling work, i snowboard....and i hit jumps, ice-skating and hockey are still fun and easy, i joined another soccer league and get this, im considered the fastest player....in the league! Im 36 now... took me 12 years to get on here just to say thank you..... feels like its to little and took to long compared to the gift he gave me. If nothing else, thank you!
Mike f

Sue Stanek

Jan 2, 2020

by Sue Stanek on Robert LaPrade, MD PhD

So glad I waited for the best

I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Previous attempts to make it better provided only temporary relief. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. I am so glad I did! Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.
You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Hey - if he is good enough for Olympic and professional athletes…..he's good enough for me! Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!
- From your 63 year old very appreciative patent ~

Nancy S Stevenson

Aug 14, 2019

by Nancy S Stevenson on Robert LaPrade, MD PhD

Right Knee Surgery After Auto Bicycle Accident

Dr. Robert F. LaPrade operated on my right knee in May of 2010. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. I can run, bike, & climb mountains. In fact 2 years ago I finished climbing the top 100 peaks in CO.