Management of Anterior Cruciate Ligament Graft Re-tear With Non-union Patellar Fracture: A Case Report

Neglected patellar fracture with concomitant anterior cruciate ligament (ACL) graft rupture is a rare entity to be encountered in clinical practice.We report a case of a 23-year-old male who presented nine months after a road traffic accident with extensor lag and knee instability who had undergone ACL reconstruction previously.Radiographs revealed a displaced inferior pole patellar fracture non-union, while magnetic resonance imaging (MRI) showed ACL graft re-tear.A staged surgical approach was planned.At first, fixation of the patellar fracture non-union with fibre-wire augmentation was done, followed by rehabilitation and subsequent revision ACL reconstruction using an ipsilateral peroneus longus graft with modified Lemaire lateral extra-articular tenodesis.At six months after the second-stage procedure, the patient achieved full, painless range of motion, restoration of extensor mechanism function, and there was no instability.This case demonstrates that staged management can provide excellent functional outcomes in such challenging clinical entities.