Osteonecrosis of the lateral femoral condyle following anterior cruciate ligament reconstruction: is bone bruising a risk factor?

Osteonecrosis of the knee is extremely rare following anterior cruciate ligament (ACL) reconstruction surgery. We report a case of osteonecrosis of the lateral femoral condyle in a patient after ACL reconstruction. The osteonecrotic lesion occurred in the same area as a large bone bruise, which was sustained at the time of the initial injury. We hypothesize that the combination of bone bruising and femoral tunnel drilling for ACL reconstruction may have compromised the overall vascularity of the articular cartilage and the subchondral bone, thereby resulting in osteonecrosis.