Ligament Reconstruction in Congenital Absence of the Anterior Cruciate Ligament

Chahla, Jorge; Pascual‐Garrido, Cecilia; Rodeo, Scott A.

doi:10.1007/s11420-015-9448-6

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…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). 13…”

Section: Introductionmentioning

confidence: 85%

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

Zhang¹,

Bauer²,

Rodeo³

2022

J Clin Transl Pathol

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Congenital absence of the anterior cruciate ligament (ACL) is an extremely rare condition associated with a wide spectrum of malformation. Here we describe a rare complication in a patient with congenital absence of the ACL after ACL reconstruction using a bioabsorbable screw. A 35-year-old woman presented a right knee mass that had been slowly growing for several months. Five years previously, she experienced acute right knee pain, locking, and instability after hiking. Images and diagnostic arthroscopy at that time revealed an absence of the anterior cruciate ligament, a hypoplastic lateral distal femoral condyle, a stenotic intercondylar notch, and hypoplastic posterior cruciate ligament along with a bucket handle tear of the medial meniscus. A right anterior cruciate ligament reconstruction was performed, and she did well for the next five years without knee joint instability until she presented a mildly painful subcutaneous pretibial soft tissue mass. Imaging studies demonstrated a 2.4 cm subcutaneous lobulated soft tissue mass protruding from the expanded tibial tunnel. The mass was excised, and the histology showed a solid and cystic lesion composed of a histiocytic and foreign body giant cell reaction to the degraded polymer along with spheres of calcium phosphate particles. At a two-year followup after debridement, the patient reported an overall improvement without any knee instability or local recurrence. To the best of our knowledge, this is the first report of a pseudotumor developed after ACL reconstruction in a patient

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Section: Introductionmentioning

confidence: 85%

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

Zhang¹,

Bauer²,

Rodeo³

2022

J Clin Transl Pathol

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“…The earliest report of ACL reconstruction in symptomatic congenital ACLD was by Katz et al [ 14 ] in 1967 on five patients with congenital knee dislocation. Subsequently, Gabos et al [ 7 ] and Chahla et al [ 8 ] reported a combination of six cases performed in patients with the classical associated limb deformities (fibular hemimelia and congenital short femur) who had previously undergone deformity correction, with decent outcomes. The management algorithm in this group of patients is clear – performing both bony correction and soft tissue (ACL) reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…The restoration of anatomical alignment and adaptation of soft-tissue structures, such as the hypertrophy of ligament of Humphrey, had often provided sufficient stability to the knee [ 7 ]. However, in cases where instability persisted, subsequent ACL reconstruction has proven useful [ 7 , 8 ]. The indication for ACL reconstruction has since been extended to treat cases of isolated congenital ACLD [ 9 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Management of Symptomatic Isolated Congenital Anterior Cruciate Ligament Deficiency with Gradual Correction of Biplanar Proximal Tibial Deformity: A Case Report

Chan¹,

Zainuddin²

2021

JOCR

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Introduction: Isolated congenital ACLD is a rare condition with limited literature on the optimal management approach. At present, patients with instability symptoms have been managed with ACL reconstruction in case reports. We present a case report of symptomatic isolated congenital anterior cruciate ligament deficiency (ACLD) managed effectively with gradual correction of biplanar proximal tibial deformity alone. Case Presentation: This was a case of bilateral isolated congenital ACLD in a 15-year-old girl with chronic bilateral knee instability, bilateral mild genu valgum, and positive Lachman’s tests. Biplanar tibial deformity was evident with a 50 proximal tibia valgus and a posterior tibial slope angle of 260 on the more symptomatic right knee. This was treated with a proximal tibial osteotomy and gradual correction with a hexapod frame using the CORA method. The right knee alignment was restored to normal. At 2-year post-surgery, her symptoms of instability had resolved, and there was a soft end point on the Lachman’s test. Conclusion: We recommend that symptomatic isolated congenital ACLD be treated by correction of any existing bony deformities first, keeping in view of ACL reconstruction if instability persists thereafter. To date, there are no reports on correction of proximal tibial deformities as the first-line treatment in isolated congenital ACLD before consideration of ACL reconstruction. To the best of our knowledge, this is the first report of symptomatic isolated congenital ACLD managed with correction of the biplanar deformity of the proximal tibia alone. Our management strategy proved to be effective in the treatment of this patient’s instability, with good post-operative outcomes. Keywords: Congenital anterior cruciate ligament deficiency, hexapod frame, deformity correction, knee instability, case report.

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“…На 22 і 23-й схрещені зв'язки виявлені у вигляді конденсації клітин із кровоносними судинами навколо них. Проте тривають дискусії, чи є зміна контурів міжвиросткової ямки стегнової кістки та міжвиросткового підвищення великогомілкової вродженими явищами або вторинною реакцією на недорозвинення схрещених зв'язок [32]. У 1967 році В. Giorgi [33] висунув теорію, що розвиток міжвиросткового підвищення великогомілкової кістки залежить від напруження схрещених зв'язок, тому їхня вроджена відсутніcть, відповідно, призводить до дисплазії цієї структури.…”

Section: результати та їх обговоренняunclassified

Knee joint instability in conditions of congenital malformations of the lower extremities

Khmyzov¹,

Yakushkin²,

Katsalap³

2021

OTP

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It is impossible to find out the number of patients with knee joint instability (KJI) in case of congenital malformations of the lower extremities (CMLE). Children, adolescents and young people usually adapt well to this abnormality, so they rarely present with symptoms of instability, even with positive tests. The main reasons for the manifestation of KJI in CMLE are inadequate loading, injuries of the lower extremity and surgical correction. Objective. Based on the assessment of the scientific literature to define the KJI terminology, to identify the main causes of its development and clinical manifestations in conditions of CMLE, to identify trends in the treatment tactics. Methods. More than 500 articles from international libraries PubMed, NCBI, Google Scholar, Medscape, MedlinePlus were searched and analyzed. Taken into account the rarity of the abnormality and the small amount of research in recent years, the depth of the search was 25 years. Results. KJI in children with CMLE may be a consequence of congenital structural features of the lower extremity (isolated malformation in the form of agenesis of the cruciate ligaments or inferiority of the ligament of the knee joint in complex abnormality) and complication of surgical correction of longitudinal defects of the extremities. As the abnormality is not well studied, the tactics for such patients still remain the topic of discussion. The expediency of surgical stabilization of the knee joint has not been conclusively proven due to the fact that in the case of its anomalies certain adaptive mechanisms are formed, which on the one hand are not appropriate to violate, and on the other hand, the current level of medicine allows to promote patients’ functional capabilities, inducing KJI progressing. Conclusions. Children with CMLE adapt well to the concomitant KJI, so in everyday life and prior to surgical correction of CMLE, it does not bother patients. Particular attention should be paid to the stability of the knee joint both before and during prolongation and correction of deformity. The variability and severity of CMLE determines the implementation of multi-stage surgical treatment and surgical stabilization of the knee joint to improve extremity function may be one of them. Key words. Children, knee joint instability, congenital malformations, lower extremities, surgical treatment.

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Ligament Reconstruction in Congenital Absence of the Anterior Cruciate Ligament

Cited by 7 publications

References 12 publications

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

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

Management of Symptomatic Isolated Congenital Anterior Cruciate Ligament Deficiency with Gradual Correction of Biplanar Proximal Tibial Deformity: A Case Report

Knee joint instability in conditions of congenital malformations of the lower extremities

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