Review and Long-Term Outcomes of Cruciate Ligament Reconstruction versus Conservative Treatment in Siblings with Congenital Anterior Cruciate Ligament Aplasia. Case Rep Orthop. 2017;2017:1636578. [PMID: 28589051 PMCID: PMC5446890 DOI: 10.1155/2017/1636578]

Management of Anterior Cruciate Ligament Aplasia for the Arthroscopy Surgeons: A Systematic Review

BACKGROUND

Anterior Cruciate Ligament Aplasia (ACLA) is a rare condition which can sometimes remain asymptomatic into adult life. Although the quoted incidence is 1.7 per 100,000 live births, it is higher due to these silent cases and can be encountered by the arthroscopy surgeon doing reconstructive procedure for the ACL. The aim of this study is to get information on clinical presentation, imaging, arthroscopy findings and management of the knee in patients with ACL aplasia through a systematic review relevant to the arthroscopy surgeon in making a decision when they encounter such a case.

METHODS

We performed a systematic review of the literature to get information on this condition that may be relevant to the arthroscopy surgeon from PubMed, Ovid full text, Embase and Ovid Medline databases. After exclusions and inclusions, we found 31 articles relevant to the search which included 101 knees.

RESULTS

Most of the publications were case reports due to the rarity of this condition. ACLA is commonly associated with Fibular Hemimelia, Congenital Dislocation of the Knee and Proximal Focal Femoral Deficiency (PFFD). Clinical findings, imaging appearances, other associated findings with ACLA have been listed and management options listed and discussed.

CONCLUSIONS

Patients with ACLA are often asymptomatic and arthroscopic reconstruction of the ACL appears to be a viable option in selected symptomatic cases only. The arthroscopic surgeon should be aware of the clinical picture and intraarticular findings of ACLA to recognize the condition and make a decision on the optimal management. Further studies are required to report on long-term outcomes of the condition in terms of secondary osteoarthritis development as well as the procedures performed. We recommend forming a global registry to study and further understand the aspects of this condition.

LEVEL OF EVIDENCE

4.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-022-00651-2.

Anterolateral Meniscofemoral Ligament Associated with Ring-shaped Lateral Meniscus and Congenital Absence of Anterior Cruciate Ligament, Managed with Ligament Reconstruction

A 24 year old otherwise healthy male presented with a chief complaint of giving way in the left knee. MRI reported complete anterior cruciate ligament (ACL) tearing. Arthroscopy showed ACL agenesis, ring-shaped lateral meniscus, and an anomalous thick band extending from the anterior horn of the lateral meniscus to the intercondylar notch of the lateral femoral condyle, which is known as the anterolateral meniscofemoral ligament (MFL). The MFL was attached to the anatomic site of anteromedial bundle of ACL. ACL reconstruction surgery was performed using central 1/3 bone tendon bone graft. Practitioners should be aware that ACL reconstruction in lateral meniscofemoral ligament with associated ACL agenesis is a treatment option in which the preservation of MFL, as the stabilizer of anterior horn of lateral meniscus, should be considered during ACL reconstruction.

How should congenital absence of cruciate ligaments be treated? A case report and literature review

BACKGROUND

Hypoplasia of bilateral cruciate ligaments is a rare congenital malformation. The diagnosis of such diseases and indications for the various treatment options require further analysis and discussion.

CASE SUMMARY

The patient is a 26-year-old Chinese woman who has been suffering from knee pain since the age of 8 years, 2-3 episodes a year. Three years ago, due to the practice of advanced yoga poses, the frequency of left knee pain increased, requiring prompt medical treatment. Magnetic resonance imaging demonstrated an absence of both anterior and posterior cruciate ligaments of both knees with abnormal posterior tilting of the tibial plateau. Bilateral subluxation of the knee joint was also found, therefore tibial osteotomy was performed. The patient reported at the 24 mo follow-up that the frequency of pain and instability had been reduced and function restored.

CONCLUSION

Osteotomy may be an effective method to treat patients with congenital cruciate ligament deficiency with posterior tibial plateau tilting. The diagnosis of congenital cruciate ligament deficiency shall be based on the combination of patient’s medical history, clinical manifestations, and findings from imaging to avoid possible misdiagnosis. Based on the symptoms, frequency of attacks, and intent of the individual, appropriate treatment options shall be identified.