Although tibial end avulsions of the anterior cruciate ligament are relatively common in clinical practice, avulsions of the femoral end of this ligament are by comparison rare. We present the case of an 11-year-old boy with a bony avulsion injury, which was presumed to have arisen from the tibial insertion of the anterior cruciate ligament but turned out instead to be an osteochondral avulsion fracture of the femoral origin. This unexpected finding that was not detected during preoperative workup resulted in the first attempt at surgical fixation being aborted. The need for a second planned definitive fixation procedure emphasises the importance of combining a thorough history and examination in association with appropriate imaging in the patient workup. The patient's definitive operative treatment and outcome are described. Although rare, surgeons (and emergency room doctors) treating such patients should include femoral end avulsion injuries of the anterior cruciate ligament in the differential diagnosis of a child presenting with an acute haemarthrosis of the knee. Furthermore, once diagnosed, early onward referral to an experienced knee surgeon is advocated.
Injury to the anterior cruciate ligament (ACL) in the pediatric population is becoming more common, with the majority of ruptures occurring at the tibial insertion site. However, to our knowledge, there are no reports of avulsion in which the primary ACL insertion site is the anterior lateral meniscal root.
We report a rare case of a pediatric ACL/anterior horn of the lateral meniscus avulsion, which was successfully repaired arthroscopically.
In this patient, neither a mid-substance tear, nor a tibial eminence fracture was noted. Instead, the patient avulsed the tibial insertion of the ACL from its small footprint, which included an extensive attachment to the lateral meniscus.
We believe this developmental anomaly may provide further support of the shared embryological origin between the ACL and menisci. In this case report, we review the literature on anterior cruciate ligament injury and repair in the pediatric population.
ACL repair; meniscus repair; pediatric
The authors report a case of acute knee injury in a 14-year-old teenager. The X-ray showed a so-called Segond’s fracture: a small avulsed bone fragment, elliptical in shape, lying immediately below the external tibial plateau, a few millimeters from the lateral tibial cortex. The fracture site was in the portion of the tibial condyle which is linked to the middle third of the lateral capsule by meniscal tibial fibers. Clinical examination under anesthesia and subsequent arthroscopy revealed a total intrasubstance ACL (anterior cruciate ligament) tear close to the proximal insertion. The authors confirm Segond’s report of a possible association of this avulsion fracture with ACL injuries, even in adolescence.
Segond fracture; ACL tear; Knee; Avulsion fracture
Tibial eminence fractures occur as a result of high amounts of tension placed upon the anterior cruciate ligament (ACL). The incidence of these fractures is higher among adolescent girls due to their inherent skeletal immaturity. In such an injury, direct trauma causes an avulsion fracture occurring at the tibial eminence while the ACL is spared. Imaging is used to confirm the diagnosis of a tibial eminence fracture and regardless of the extent of injury, rehabilitation is crucial for a full recovery. The following is a case study of a 17-year-old girl who was involved in a motor vehicle accident. In the accident, she sustained a left lateral tibial eminence fracture, along with soft tissue injuries at the cervical and lumbar spine. Her treatment included passive and active range of motion (ROM), strength training, physical modalities, and proprioceptive training of the injured areas. An improvement was noted post-treatment and after a 5-month follow-up according to subjective reports and objective assessments (ROM and girth measurements).
tibial eminence; fracture; rehabilitation; éminence du tibia; fracture; réadaptation
Magnetic resonance imaging (MRI) findings in anterior cruciate ligament (ACL) injury are well known, but most published reviews show obvious examples of associated injuries and give little focus to paediatric patients. Here, we demonstrate the spectrum of MRI appearances at common sites of associated injury in adolescents with ACL tears, emphasising age-specific issues.
Pictorial review using images from children with surgically confirmed ACL tears after athletic injury.
ACL injury usually occurs with axial rotation in the valgus near full extension. The MRI findings can be obvious and important to management (ACL rupture), subtle but clinically important (lateral meniscus posterior attachment avulsion), obvious and unimportant to management (femoral condyle impaction injury), or subtle and possibly important (medial meniscocapsular junction tear). Paediatric-specific issues of note include tibial spine avulsion, normal difficulty visualising a thin ACL and posterolateral corner structures, and differentiation between incompletely closed physis and impaction fracture.
ACL tear is only the most obvious sign of a complex injury involving multiple structures. Awareness of the spectrum of secondary findings illustrated here and the features distinguishing them from normal variation can aid in accurate assessment of ACL tears and related injuries, enabling effective treatment planning and assessment of prognosis.
• The ACL in children normally appears thin or attenuated, while thickening and oedema suggest tear.
• Displaced medial meniscal tears are significantly more common later post-injury than immediately.
• The meniscofemoral ligaments merge with the posterior lateral meniscus, complicating tear assessment.
• Tibial plateau impaction fractures can be difficult to distinguish from a partially closed physis.
• Axial MR sequences are more sensitive/specific than coronal for diagnosis of medial collateral ligament (MCL) injury.
Knee; Anterior cruciate ligament; Menisci; Adolescent; MRI
The anterior cruciate ligament (ACL) is a stabilizing structure to both anterior translation of the tibia with respect to the femur as well as rotation of the knee joint. Children and adolescents are susceptible to these injuries, and there are some who believe the incidence of ACL injuries in this population is increasing due to year round single sport participation. Pediatric ACL injuries are typically seen in several forms: tibial avulsion fractures, partial ACL tears, and full thickness ligament tears. There were and still are some who feel that ACL injuries should be treated non-operatively in the pediatric and adolescent population; however, recent literature refutes this notion. Several factors must be considered during pediatric and adolescent ACL reconstruction, each of which will be examined in this manuscript, including: status of the physis, reconstruction technique, and graft source.
Pediatric; Anterior cruciate ligament; ACL; Graft; Growth disturbance; Malalignment
Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, which presented as a diagnostic challenge. Clinically, the fracture mimicked a low-grade infection of the surgical site, while radiographically, the fracture resembled an avulsion fracture, later confirmed as a tibial tunnel fracture with computed tomography. With the ACL graft integrity not in jeopardy, four weeks of non-weightbearing and a delayed post-operative rehabilitation program was effective in allowing the fracture to heal. Good functional outcome was achieved after conservative management, with minimal loss of terminal knee extension and minimal pain at 22-month follow-up.
tibial plateau; fracture; ACL reconstruction; complication; conservative management; plateau tibial; chirurgie reconstructive du LCA; complication; gestion conservatrice
The treatment of an anterior cruciate ligament (ACL) avulsion fracture is controversial, especially in skeletally immature patients, because of concerns about physeal damage. To reduce the risk of physeal injury, an arthroscopic technique was performed. A bioabsorbable suture anchor was inserted through anteromedial portals and fixed to a bioabsorbable suture anchor at the center of the fracture bed; it was then passed through the threads at the ACL avulsion fragment and tied with the ACL substance. After this, the avulsion fragment was repaired by an all-inside technique between the distal portion of the ACL and the transverse ligament and periosteum by a suture hook. The arthroscopic hybrid technique using a suture anchor with an all-inside repair is more rigid and safe. In addition, this physeal-sparing fixation is possible in immature patients.
Recent years have seen ACL reconstruction performed in a broad range of patients, regardless of age, sex or occupation, thanks to great advances in surgical techniques, instrumentation and the basic research. Favorable results have been reported; however, we have not been able to locate any reports describing ACL reconstruction in patients with athetoid cerebral palsy.
We present herein a previously unreported anterior cruciate ligament (ACL) reconstruction performed in a patient with athetoid cerebral palsy. The patient was a 25-year-old woman with level II athetoid cerebral palsy according to the Gross Motor Function Classification System. She initially injured her right knee after falling off a bicycle. Two years later, she again experienced right-knee pain and a feeling of instability. A right-knee ACL tear and avulsion fracture was diagnosed upon physical examination and confirmed with magnetic resonance imaging (MRI) and X-ray examination at that time. An ACL reconstruction using an autologous hamstring double-bundle graft was performed for recurrent instability nine years after the initial injury. Cast immobilization was provided for 3 weeks following surgery and knee extension was restricted for 3 months with the functional ACL brace to prevent hyperextension due to involuntary movement. Partial weight-bearing was started 1 week postoperatively, with full weight-bearing after 4 weeks. The anterior drawer stress radiography showed a 63% anterior displacement of the involved tibia on the femur six months following the surgery, while the contralateral knee demonstrated a 60% anterior displacement of the tibia. The functional ACL functional brace was then removed. A second-look arthroscopy was performed 13 months after the ACL reconstruction, and both the anteromedial and posterolateral bundles were in excellent position as per Kondo’s criteria. The Lachman and pivot shift test performed under anesthesia were also negative. An anterior drawer stress radiography of the involved knee at 36 months following surgery showed a 61% anterior translation of the tibia. The preoperative symptoms of instability resolved and the patient expressed a high degree of satisfaction with the result of her surgery.
Athetoid cerebral palsy; Anterior cruciate ligament reconstruction; Involuntary movement; Stress radiography
To the best of our knowledge there is no other report of an elderly patient who was surgically treated for a patellar fracture with tension band wiring and who subsequently suffered from an avulsion fracture of the tibial tuberosity. The combination of a patellar fracture and avulsion of the patellar ligament has only been described as complication after bone-patellar tendon-bone anterior cruciate ligament reconstructions. However, due to demographic changes and more elderly patients treated this injury may become more frequent in future.
We present the case of an 81 year old female who sustained an oblique patellar fracture after a direct contact injury of the left knee when falling on ice. Consequently the patellar fracture was openly reduced and stabilized with tension band wiring. The follow-up was uneventful till three months after surgery when the patient noticed a spontaneous avulsion fracture of the tibial tuberosity (Ogden type 3). The tibial tuberosity fragment was reattached with two non-resorbable sutures looped around two modified AO cortical 3.5 mm long neck screws. Intraoperatively multiple bone cysts were seen. Biopsies were not taken to prevent further fragmentation of the tibial tuberosity. The patient was followed up with anteroposterior and lateral full weight bearing radiographs and clinical assessment at 6, 12 weeks and 6 months after surgery. Recovery was completely pain free with full satisfaction.
In conclusion in elderly patients with a patella fracture a possible associated but not obvious fracture of the tibial tuberosity should be ruled out and the postoperative rehabilitation protocol after tension band wiring of the patella might have to be individually adjusted to bone quality and course of the fracture.
Posterior cruciate ligament (PCL) insertion-site osteochondral avulsions in children, particularly from the tibia, are not commonly seen by orthopaedic surgeons. Because of the rarity of these injuries, careful attention to the specific physical examination and imaging findings seen with these injuries is necessary so that the proper diagnosis can be made. Osteochondral avulsions of the PCL can be missed on plain radiographs in skeletally immature patients, and therefore magnetic resonance imaging is necessary for proper diagnosis. With this knowledge, clinicians can formulate treatment plans which can return their patients to activities while avoiding potential morbidity resulting from missed diagnoses or improper treatment. We report two rare cases of PCL insufficiency stemming from tibial insertion osteochondral avulsions. Both patients underwent subsequent open reduction and internal fixation of the avulsion using two different fixation methods (bioabsorbable anchors versus cannulated screw and washer) and have returned to full sporting activities.
Electronic supplementary material
The online version of this article (doi:10.1007/s11999-008-0373-6) contains supplementary material, which is available to authorized users.
Anterior cruciate ligament (ACL) avulsion fracture is commonly associated with knee injuries and its management is controversial ranging from conservative treatment to arthroscopic fixation. The aim of our study was to assess the clinical and radiological results of arthroscopic staple fixation in the management of ACL avulsion fractures.
Materials and Methods:
Twenty-two patients (17 males and 5 females) who underwent arthroscopic staple fixation for displaced ACL avulsion fractures were analysed. The mean age was 32.2 years (15-55 years) with a mean followup of 21 months (6-36 months). All patients were assessed clinically by calculating their Lysholm and International Knee Documentation Committee (IKDC) scores and the radiological union was assessed in the followup radiographs.
The mean Lysholm score was 95.4(83-100) and the mean IKDC score was 91.1(77-100) at the final followup. In 20 patients anterior drawer's test was negative at the end of final followup while two patients had grade I laxity. Associated knee injuries were found in seven cases. The final outcome was not greatly influenced by the presence of associated injuries when treated simultaneously. At final followup all the patients were able to return to their pre-injury occupation
Arthroscopic staple fixation is a safe and reliable method for producing clinical and radiological outcome in displaced ACL avulsion fractures.
ACL avulsion; arthroscopy; staple
Avulsion fractures of the posterior cruciate ligament (PCL) are uncommon. On the basis of the site of damage of the PCL, hyperflexion, pretibial trauma, and hyperextension are proposed as mechanisms of PCL injuries. On the other hand, avulsion fractures of the tibial condyle are also rare. We report a PCL-mediated avulsion fracture of the lateral tibial condyle along with the tibial insertion of the PCL by extension-distraction force on the knee that has not been previously described in any study. This rare case may imply that application of an extension-distraction force to the PCL cause the avulsion fracture.
Bone bruise patterns are commonly seen after acute anterior cruciate ligament injuries; they represent a subchondral impaction injury that occurs in the lateral knee joint between the mid-lateral femoral condyle and the posterior lateral tibial plateau. These contusion patterns are present in the majority of noncontact ACL injuries. These injury patterns vary significantly in severity and this aspect is poorly understood. Edema patterns have gained increased interest in the literature of late; they may indicate the severity of the initial injury. They also may be correlated with the development of subsequent osteochondral defects and osteoarthritis. Given the location of this subchondral injury, it is plausible to assume that the geometry of the lateral femorotibial joint may play a role in ACL injury mechanism and severity of injury. We are reporting two cases of clinically identical ACL injuries. A patient with a flat lateral tibial plateau was noted to have a much larger bone edema pattern than a second patient with the highly convex lateral tibial plateau. This may shed light on the pathomechanics of ACL injury and suggests that an individual with a relatively flat tibial plateau has a stable lateral knee joint. Therefore, we hypothesize that much greater force is required to dislocate a flat and stable lateral femorotibial joint in a pivot shift pattern to produce an ACL injury. The greater force required results in a large bone edema pattern. Conversely, the individual with a relatively short and convex tibial plateau has an inherently unstable lateral joint and relatively smaller amounts of force would be needed to produce the identical injury to the ACL. As less force is required, smaller bone edema patterns result.
Clinical, arthrographic, and arthroscopic findings in 53 patients with acutely torn anterior cruciate ligaments (ACLs) were documented. Arthroscopy and instability tests under anesthesia were performed on all patients within 2 weeks after the initial injury. Twenty-three patients complained of extension blocks, and localized tenderness on the medial side was revealed in 26 patients at the initial examination. Aspiration from joints exhibited hemarthrosis in 52 patients. Arthroscopy revealed ACL ruptures in all patients. Four Segond's fractures, 26 meniscus tears (8 medial and 18 lateral), 1 osteochondral fracture, and 19 medial collateral ligament ruptures were revealed. Arthroscopy detected only 1 of the 5 ruptures of the posteromedial corner of the medial meniscus, which were noted on arthrography. Three ACL stumps were protruding among the femorotibial joint, which seemed to be restricting full extension. Statistical analysis showed that tenderness on the medial side was not revealed more frequently in knees with medial collateral ligament injuries than in the others. The volume of aspirated fluids in knees with no leakage in arthrography significantly increased over those with leakages (p < 0.05). Diagnosis of ACL injuries should be completed by clinical, arthrographic, and arthroscopic examinations.
34 cases of avulsion fractures are described. Each fracture took place during athletic training or competition. Excepting six sportsmen participating in a general fitness programme, every patient was an active competitive athlete. There were six women and 28 men; their average age was 20.1 years, raised by a few middle-aged "fitness sportsmen". Most avulsion fractures took place in sprinters and hurdlers; next were middle and long distance renner, footballers, fitness joggers, skiers and ice-hockey players. The most usual location of a fracture was the anterior pelvic spines; avulsion fractures were also detected in various parts of lower limbs. There were fewer avulsion fractures in the area of the trunk and upper extremities. Roetgenologically, the diagnosis of an avulsion fracture is generally easy to make. However, the diagnosis is facilitated by knowing the mechanism of the injury, the technique of the athletic event, and some of the training methods. Generally, a fracture heals well, even if it requires both sufficient immobilisation and some delay in resuming physical exertion.
We present a case of a chondral lesion after anterior cruciate ligament (ACL) reconstruction caused by femoral cross-pin breakage and intra-articular migration of the fragment. A 20-year-old man initially underwent ACL reconstruction using a hamstring autograft. The RigidFix bioabsorbable cross-pin (DePuy Mitek) was used for the femoral fixation. The patient returned to a pre-injury level of activity (professional soccer player) 6 months postoperatively. However, 20 months postoperatively, the patient presented with effusion and lateral joint-line pain after practice, without signs of instability in clinical examination. Conservative treatment failed and at re-arthroscopy a chondral lesion of the lateral femoral and tibial condyle was found, which had been caused by the broken femoral cross-pin. The fragment was removed and the symptoms resolved. Orthopaedic surgeons should be aware of this complication when using a bioabsorbable cross-pin for femoral fixation in ACL reconstruction.
To present the case of a collegiate athlete with an atraumatic osteochondral fracture influenced by the presence of osteoarthritis.
Osteochondral fractures are fairly common occurrences in athletes, although it can be difficult to recognize such an injury in the absence of a traumatic event. Osteoarthritis is 1 condition that can increase an athlete's susceptibility to an atraumatic osteochondral fracture. However, because of the atraumatic nature of the injury, the possibility of an osteochondral fracture may be overlooked.
Meniscal damage, osteochondritis dissecans, patellofemoral disorders.
The osteochondral fragment was surgically removed, and fibrous growth was encouraged by drilling and laser smoothing.
Osteochondral fractures are usually associated with some type of traumatic mechanism, such as a rotational and compressive force. Also, osteoarthritis is not common in young collegiate athletes. However, this 20-year-old volleyball player had no apparent injury and lacked the usual signs and symptoms (eg, locking, giving way, crepitus, loss of range of motion) associated with an osteochondral fracture. The athlete's susceptibility to an osteochondral fracture was increased by the presence of osteoarthritis.
The athletic trainer should consider the possibility of an osteochondral fracture in an athlete with persistent effusion and pain in the absence of a traumatic mechanism of injury.
osteochondritis dissecans; knee injury
Health-related quality of life (HRQoL) in anterior cruciate ligament (ACL) insufficiency has not been assessed in comorbid-free patients to date. An observational study was therefore conducted on a practice-based sample to test the hypothesis that SF-36 scoring in patients with chronic ACL insufficiency differs from the age- and gender-matched Italian norm.
Materials and methods
Chronically ACL-insufficient patients with or without meniscal and/or focal chondral lesions were enrolled in the study. Exclusion criteria were acute ACL tear, severe and diffuse chondral lesions, concomitant knee major ligamentous injuries and/or fractures requiring surgery, previous ACL surgery and infectious, neoplastic and inflammatory disease. Knee function was evaluated by International Knee Documentation Committee (IKDC) form, HRQoL with the SF-36 questionnaire, and associated medical comorbidities by a Self-Administered Comorbidity Questionnaire (SCQ).
A total of 316 consecutive patients, 265 males and 51 females (median age 25 years, range 15–52 years) met the inclusion/exclusion criteria. SF-36 norm-based scoring showed that the Physical Functioning, Role Physical, Bodily Pain, and Social Functioning domains were significantly lower than the Italian norm; the Role Emotional domain was also lower than the norm, but the difference was not significant. Conversely, the General Health and Mental Health domains scored significantly higher than the norm; the Vitality domain also exceeded, albeit not significantly, the norm.
The decision-making process leading to ACL reconstruction currently emphasises the evaluation of knee function and patients’ level of activity. The findings in our study, by showing that chronic ACL insufficiency significantly affects HRQoL in otherwise healthy patients, suggest that a multidimensional evaluation including HRQoL in addition to knee function might be integrated into outcome assessment.
Anterior cruciate ligament; Reconstruction; Normative group; SF-36; Quality of life
The aim of this prospective study was to compare and correlate clinical, magnetic resonance imaging (MRI), and arthroscopic findings in cases of meniscal tear and anterior cruciate ligament (ACL) injuries. MRI scan results and clinical diagnosis are compared against the arthroscopic confirmation of the diagnosis. One hundred and thirty-one patients had suspected traumatic meniscal or anterior cruciate ligament (ACL) injury. Clinical examination had better sensitivity (0.86 vs. 0.76), specificity (0.73 vs. 0.52), predictive values, and diagnostic accuracy in comparison to MRI scan in diagnosis for medial meniscal tears. These parameters showed only marginal difference in lateral meniscal and anterior cruciate ligament injuries. We conclude that carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison to MRI scan. MRI may be used to rule out such injuries rather than to diagnose them.
To describe the evaluation, diagnosis, and conservative treatment of a 15-year-old male high school football player with an avulsion fracture of the ischial tuberosity.
Avulsion fracture of the ischial tuberosity is a rare and often missed diagnosis. A literature review offered limited information concerning the evaluation and conservative treatment of such an injury.
Avulsion fracture of the ischial tuberosity.
The athlete's treatment goal was to return to football and weight lifting without surgical intervention. Treatment initially focused on controlling pain and normalizing gait. The athlete then advanced to a progressive resistance exercise program and functional sporting drills as he improved in hip range of motion, strength, and neuromuscular control. He returned to unrestricted sporting activities 14 weeks after the injury.
Avulsion of the ischial tuberosity is a rare injury. Most published case reports have recommended surgical intervention for this injury, with little information describing conservative treatment.
Sports medicine practitioners must obtain an accurate history, perform a thorough physical examination, and obtain appropriate radiographs in order to correctly diagnose an ischial tuberosity avulsion fracture. Furthermore, they should consider conservative treatment for minimally displaced ischial tuberosity avulsion fractures. Should the athlete not show significant functional gains within a month of conservative treatment, the health care provider should consider surgical treatment.
tuberosity avulsion; hip pain; rehabilitation
OBJECTIVES—To investigate the effects of collagen induced arthritis (CIA) on the tensile properties of rat anterior cruciate ligament (ACL).
METHODS—The tensile strength, bone mineral density (BMD), and histology of ACL units from rats with CIA were investigated.
RESULTS—The tensile strength of the ACL unit was significantly lower in the rats with CIA at 10 weeks after immunisation (ultimate failure load, 74.9% of the control; stiffness, 62.0% of the control). The major mode of failure was femoral avulsion, and the BMD was significantly lower in the rats with CIA. A histological examination of the ligament insertion in rats with CIA showed resorption of the cortical bone beneath the ACL insertion and an enlarged mineralised fibrocartilage zone.
CONCLUSIONS—These findings indicate that the decrease in tensile strength of ACL units correlated with histological changes in the ligament-bone attachment, such as bone resorption beneath the ligament insertion site and an enlargement of the mineralised fibrocartilage zone.
Bucket handle meniscal tears (BHMT) of the knee occur infrequently (approximately 10% of meniscal injuries). Simultaneous, bicompartmental BHMT are extremely rare. Previously, these have only been reported in association with a ruptured anterior cruciate ligament (ACL). The pathomechanism of this injury was thought to be due to the lack of knee stability following the ACL injury. We present a case of a 38 year old male patient with bicompartmental BHMT with a clinically competent ACL. This highlights the need for clinical and radiological suspicion of simultaneous BHMTs even in the presence of an intact ACL.
Posterior cruciate ligament injuries can occur as isolated ligament ruptures or in association with the multiligament-injured knee. Delayed reconstruction, at 2–3 weeks post-injury, is predominantly recommended for posterior cruciate ligament tears in the multiligament-injured knee. While acute bone and soft tissue avulsion patterns of injury can be amenable to repair, the described techniques have been associated with some difficulties attaching the avulsed ligament.
Description of Technique
As part of a reconstruction/repair of a multiligament-injured knee, we performed arthroscopic primary repair of the posterior cruciate ligament by passing Bunnell-type stitches into the substance of the ligament using a reloadable suture passer. We then passed the sutures through drill holes into the femoral footprint of the ligament and tied them over a bony bridge.
Patients and Methods
We retrospectively reviewed three patients with posterior cruciate ligament tears associated with a multiligament-injured knee. All patients had posterior cruciate ligament soft tissue avulsions or “peel off” injuries diagnosed by MRI. The described repair technique was used to repair the posterior cruciate ligament avulsion. Minimum followup was 64 months (mean, 68 months; range, 64–75 months). ROM, stability testing, and functional outcome scores (Lysholm and modified Cincinnati) were recorded.
Mean ROM was 0° to 127°. Posterior drawer testing was negative in all three patients. The mean Lysholm score was 92 and the mean modified Cincinnati score was 94. Followup MRI confirmed ligament healing in all patients.
We believe arthroscopic posterior cruciate ligament repair for soft tissue peel off injuries is a technique that, when applied to carefully selected patients, may be helpful to the surgeon treating patients with a multiligament-injured knee.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Electronic supplementary material
The online version of this article (doi:10.1007/s11999-011-2034-4) contains supplementary material, which is available to authorized users.
A case of synovial chondromatosis originating from the synovium of the anterior cruciate ligament (ACL) resulting in a mechanical block to knee extension is reported. A 36-year-old man complained of a restricted range of left-knee motion and pain when walking. Plain roentgenograms showed normal appearance, however, magnetic resonance imaging showed intensity changes in the ACL. Arthroscopically, numerous small free bodies were observed. Proliferation of synovium and cartilaginous tissues were identified around the ACL. There were no significant findings in the synovium except around the ACL. The synovium around the ACL was resected and free bodies were washed out. This is the first report of synovial chondromatosis originating from the synovium of the ACL.