Intraoperative Hoffa fracture during primary ACL reconstruction: can hamstring graft and tunnel diameter be too large?

Intraoperative fracture during tunnel placement in primary anterior cruciate ligament (ACL) reconstruction is rarely reported. To our knowledge, this is the first case report of an intraoperative distal femoral coronal plane (Hoffa) fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We discuss the potential ramifications of such a complication in the context of the current emphasis placed on large graft and femoral tunnel sizes.