ACL Graft Rupture

Case
A 21-year-old female player presented after a twisting injury to her left knee. She describes a feeling of instability in her knee, rapid swelling and an inability to continue to playing. On examination, she had gross laxity with Lachmans test, an effusion and a restricted ROM.

The player had a history of a previous ACL reconstruction (ACLR). This was done using hamstring autograft two years previously. At the time of this surgery (done in another country), her operation note reports that she had both medial and lateral meniscal repairs. She recovered well from this surgery and had been playing elite football for more than one year.

Findings
The ACL graft is ruptured with a loss of the normal ACL contour and signal. There is a focal area of full-thickness cartilage loss on the posterior, weight-bearing portion of the lateral femoral condyle. This measures approximately 15 x 10 mm. There is also thinning and irregularity of the articular cartilage involving the posterior aspect of the lateral tibial plateau with a small area of full-thickness cartilage loss and subchondral reactive change. These chondral changes were not present at the time of her first surgery. There appears to have been trimming of the mid and posterior thirds of both menisci. These meniscal remnants are small and irregular.

Discussion
This player opted to have a revision ACLR. This was done using bone-patella-bone autograft and augmented with an ALL tenodesis.  She also had a chondroplasty and further partial medial meniscectomy.  She is currently three months post-surgery and is progressing well with her rehabilitation.

This case highlights several important points related to ACL injuries.  Firstly, there is a high rate of re-injury.  Data from various registries and cohort studies suggests that the risk of sustaining a further ACL injury (either to the injured or contralateral knees) is approximately 30% for young, active patients who return to change of direction sports like football.  Secondly, there is a high incidence of further chondral and meniscal injuries as well as post-traumatic osteoarthritis.  Despite the initial surgeon’s attempts to repair the meniscal injuries after this player’s first ACL injury, she has gone on to develop significant chondral pathology.  This has occurred over a relatively short period. Finally, this case re-enforces the need to advocate ACL prevention programmes. Despite this player’s high risk for re-injury, she was never told about prevention programmes, like the 11+. When done regularly these programmes have been shown to reduce the risk of ACL injury by approximately 50%. Given that these programmes are likely more effective in higher risk populations the value to this particular player may have been even greater.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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Jamaleddine@132Dr AKarthick KDR.Shailendra PatilDr wazir ndonde Recent comment authors
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Taha hdd
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Taha hdd

That was great
Thank you

Prof. Bilal Obeid
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Prof. Bilal Obeid

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Ahmed mebarki
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Ahmed mebarki

Thanks for this informations

Prof. Bilal Obeid
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Prof. Bilal Obeid

please sign and share my petition: Ozone Autohemotherapy: Potential use in COVID-19 management.
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amine
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amine

thanks 😍

Prof. Bilal Obeid
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Prof. Bilal Obeid

please sign and share my petition: Ozone Autohemotherapy: Potential use in COVID-19 management.
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Alyaa Ali Atiyah
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Alyaa Ali Atiyah

شكراعلى المعلومات

Prof. Bilal Obeid
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Prof. Bilal Obeid

please sign and share my petition: Ozone Autohemotherapy: Potential use in COVID-19 management.
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bangoura
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bangoura

DANS LE CAS D UNE RUPTURE DU LCA L INTERVENTION CHIRURGICALE COMMUNEMENT APPELLEE LIHAMENTOPLASTIE CONSIDTE A RECONSTRUIRE LE LIGAMENT ROMPU. AVOIR A L ESPRIT QUE QUELQUES CAS DE RUPTURE DU LCA PEUVENT ETRE TRAITES ORTHOPEDIQUEMENT( ATTELE PLATRE) LA RUPTURE DU GREFFON INTERVIENT SOIT PAR INCOMPATIBILITE DU DONNEUR SOIT PAR LA TECHNIQUE OPERATOIRE DU CHIRURGIEN.. UNE TORTION FORCEE DU GENOU EN VALGUS OU EN VARUM PEUT ENTRAINER UNE RUPTURE DU GREFFON.. LA COMPLICATION LA PLUS FREQUENTE DU ĢREFFON EST SECONDAIRE A UN CONFLIT MECANIQUE. LE GREFFON EST AVASCULAIRE IL REVIENT AU CHIRURGIEN DE PRENDRE UNE DECISION POUR UNE SECONDE INTERVENTION SURTOUT… Read more »

Aldo
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Aldo

Thanks

Alyaa Ali Atiyah
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Alyaa Ali Atiyah

جميل جدا

Dr WAZIRI ndonde
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this is very important case study for ACL grafty

Thanks for sharing

DR.Shailendra Patil
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DR.Shailendra Patil

This really great case study in ACL. Thanks, for sharing.

KARTHICK K
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KARTHICK K

It’s really useful . Great information

KARTHICK K
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KARTHICK K

this is very important case study for ACL grafty

Thanks for sharing

Mimi
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Mimi

La greffe du tendon rotulien donne plus de stabilité par rapport kj par rapport a la technique de Lemaire

Jamaleddine almouhandiz
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Jamaleddine almouhandiz

شكرا على هده المعلومات