Stress fracture in athletes after reconstruction of the anterior cruciate ligament of the knee – case reports and literature review

Abstract

Objectives We purpose to report two cases of stress fractures in amateur athletes after anterior cruciate ligament reconstruction (ACLR) and review literature data. Methods Case Presentation: The first case involved a 30-year-old male, who underwent ACLR with hamstring autograft. Post-surgery, he recovered well and returned to sports after 9 months. However, he later experienced pain, swelling, and reduced joint motion, revealing a low-risk, grade III stress fracture in the postero-medial region of the proximal tibia. The second case featured a 34-year-old male with ACL injury, successfully treated with ACLR using hamstring autograft. Despite a smooth recovery, he developed pain and swelling, uncovering a low-risk, grade III stress fracture in the postero-medial proximal tibia during follow-up examinations. Results Two rare stress fracture cases in the tibial plateau post-ACLR are reported in amateur athletes. Following initial recovery, both experienced pain, swelling, and reduced knee motion. MRI revealed low-risk stress fractures in the postero-medial proximal tibia (grade III). Management involved a two-phase protocol: pain control, activity modification, and physiotherapy (1); gradual return to sports with predisposing factor correction (2). The paper discusses the rarity of such fractures in healthy athletes, emphasizing tibial tunnel positioning and biomechanical factors. Genetic susceptibility to stress fractures is considered. Evaluation of acutely painful knees post-ACLR should include stress fracture assessment, emphasizing early MRI diagnosis and established management principles. Conclusion In conclusion, stress fractures in the proximal tibia following ACLR are infrequent, especially in athletic individuals, highlighting the need for continued research into contributing biomechanical factors, optimal tunnel positioning, and genetic influences. Management protocols involve early detection through MRI and a phased approach to rehabilitation, emphasizing the significance of individualized patient care.