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

Abstract

BACKGROUNDHypoplasia 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 SUMMARYThe 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.CONCLUSIONOsteotomy 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.

Pseudotumor Associated with a Bioabsorbable Screw in a Patient with Reconstructed Congenital Absence of the Anterior Cruciate Ligament: a Case report

“…Some authors recommend conservative treatment as many patients may not have any symptoms, as they may have adapted to these developmental abnormalities. 9,18 Other studies have reported favorable outcomes with ACLR for symptomatic patients. One of the largest series was reported by Sachleben et al 12 from the Boston Children's Hospital, Boston, MA, USA.…”

“…Based on a review of previous publications, 31% of patients start experiencing pain and instability due to mild trauma. 9 Isolated case reports have also indicated that patients with this disorder might progress to earlier knee osteoarthritis. 10,11 Given the rarity of the condition and wide spectrum of malformation, there is still no consensus regarding the optimal treatment.…”

“…10,11 Given the rarity of the condition and wide spectrum of malformation, there is still no consensus regarding the optimal treatment. 9 While selecting treatment options is required on a case-bycase assessment, many studies have reported clinical improvement after anterior cruciate ligament reconstruction (ACLR) for symptomatic patients. [12][13][14] Here we describe a rare complication in a patient with leg length discrepancy and congenital absence of the ACL after ACL reconstruction using a bioabsorbable screw (part of the case was previously reported).…”

Versican contributes to ligament formation of knee joints

“…In humans, congenital absence of cruciate ligaments shows similar defects, and the patients acquire osteoarthritis at later ages [41,42]. As Vcan complete knockout mice are embryonic lethal due to cardiac defects, Vcan is unlikely to be associated with this disease.…”

Aplasia of the posterior cruciate ligament: case report and review of the literature

“…Reviewing the literature, a few articles were published to discuss aplasia or hypoplasia of the cruciate ligaments (3)(4)(5)(6)(7)(9)(10)(11). Up to date, no previous case was available in the literature, demonstrating aplasia of the posterior cruciate ligament in a young patient.…”