A Rare Case of Knee Orthogonal Injury in a Poliotic Limb, Managed - Arthroscopically

Sep 29, 2026

Single-stage fully arthroscopic fixation is presented for a rare medial Hoffa fracture occurring with complex intra-articular knee injuries, including anterior cruciate ligament, medial collateral ligament, and meniscal tears. The case involves a 42-year-old male who presented 5 days after a slip-and-fall injury with swelling, instability, and pain, in the setting of a poliotic lower limb. Arthroscopy-assisted reduction and internal fixation enabled anatomical reduction and simultaneous management of ligament and meniscal pathology, addressing unique anatomical and biomechanical challenges. Key outcomes emphasize effective visualization, fixation, and repair in a challenging clinical scenario.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Introduction

Case Report

Conclusion

Keywords

Introduction

Background on Hoffa fractures

Arthroscopy-assisted reduction and internal fixation (ARIF)

Complex orthogonal injuries and polio-related challenges

Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 177-182 A Rare Case of Knee Orthogonal Injury in a PolioticLimb, Managed Arthroscopically Rahul Kakran¹, Ashish Kumar Agarwal ¹, Vinay Sharma¹, Vipin Tyagi¹ Learning Point of the Article: Arthroscopic fixation provides excellent visualization of the joint, helps achieve anatomical reduction, and allows simultaneous management of ligament and meniscal injuries. Poliotic limbs present unique anatomical and biomechanical challenges; however, with proper technique and adaptation, good functional outcomes are possible. Abstract Introduction: Medial Hoffa fractures are exceptionally rare, especially when associated with intra-articular knee injuries (anterior cruciate ligament, medial collateral ligament, and meniscus tears). The discussed case highlights a single-stage fully arthroscopic fixation of a medial Hoffa fracture with associated ligament and meniscal injuries–representing a novel and effective, though challenging, treatment option. This is the first report of this kind in the literature. Case Report: A 42-year-old male patient presented 5 days after an injury to the left knee after a slip and fall in the bathroom. The knee was swollen, unstable, and painful, and the patientwas aknown case of leftpoliotic lowerlimb. Conclusion: This case represents the first documented instance of a fully arthroscopic fixation ofa medial Hoffa fracture with simultaneous ligament and meniscalrepair ina polioticpatient. Keywords: Hoffa’s fracture, arthroscopic, polio. Introduction Coronal plane fractures ofthe distal femoral condyle are labeled as Hoffa fractures. Albert Hoffa gave an initial account of these fractures in 1904. The distal fragment, owing to no muscle attachment, acts as a freely lying, large, intra-articular bone piece. This fragment is bathed in a pool of synovial fluid and is commonly a cause of non-union in conservatively managed and neglected fractures. Other complications include knee joint osteoarthritis and knee stiffness. Hence, early anatomical reduction and internal fixationremains the treatment of choice. Arthroscopy-assisted reduction and internal fixation (ARIF) of these fractures is a novel technique with a minimally invasive procedure. This avoids large soft-tissue disruption and helps in early recovery with less morbidity. We hereby present a case of medial condyleHoffa fracture, which was managed by ARIF. Although these fractures usually occur in isolation, they may rarely combine with ligamentous or meniscal injuries, forming complex orthogonal injuries. Their rarity makes treatment challenging, especially in poliotic patients, where altered anatomy, bone strength, and soft tissues add further difficulty for the surgeon. We present areview of the current literature and salient points for |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6498](https://doi.org/10.13107/jocr.2025.v15.i12.6498) | Author’s Photo Gallery | | | | | --- | --- | --- | --- | --- | | | |
Dr. Ashish Kumar Agarwal | | | | |
1Department of Orthopaedics, Yashoda Group of Hospitals, Ghaziabad, Uttar Pradesh, India.
Address of Correspondence:
Dr. Rahul Kakran,
Department of Orthopaedics, Yashoda Group of Hospitals, Nehru Nagar and Vasundhra, Ghaziabad, Uttar Pradesh, India.
E-mail: [rahul.kakran@yahoo.com](rahul.kakran@yahoo.com) | | | | | Submitted: 13/09/2025; Review: 04/10/2025; Accepted: November 2025; Published: December 2025 | | | | | | DOI: [https://doi.org/10.13107/jocr.2025.v15.i12.6498](https://doi.org/10.13107/jocr.2025.v15.i12.6498)
© The Author(s). 2025 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)), which permits unrestricte

FAQs

Why is medial Hoffa fracture with intra-articular knee injuries considered exceptionally rare?

Medial Hoffa fractures are uncommon, and their association with intra-articular injuries such as ACL, MCL, and meniscus tears is particularly rare, making combined orthogonal injuries difficult to manage.

What was the patient’s clinical presentation and timeline in the case report?

A 42-year-old male presented 5 days after a slip-and-fall injury to the left knee. The knee was swollen, unstable, and painful, and he was a known case of poliotic lower limb.

How did the fully arthroscopic approach support treatment of both fracture fixation and associated soft-tissue injuries?

Arthroscopic fixation provides excellent joint visualization, supports anatomical reduction, and allows simultaneous management of ligament and meniscal injuries while minimizing soft-tissue disruption.

Sep 29, 2026

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