ACL Graft Rupture

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This young, recreational football player presented after a twisting injury to her left knee.  She had a previous history of an anterior cruciate ligament reconstruction with partial medial and lateral meniscectomies three years previously.  She was found to have a gross effusion as well as laxity with Lachman’s test.  She had a limitation in movement and generalised tenderness around the knee.

An x-ray image was unremarkable.  An MRI scan unfortunately confirms a ruptured anterior cruciate ligament graft.  There is also evidence of past medial and lateral partial meniscectomies.  Associated with this is an area of full thickness articular cartilage loss involving the posterior weight bearing portion of the lateral femoral condyle and posterior aspect of the lateral tibial plateau.

This patient was managed with an ACL graft revision reconstruction.  She was also treated with a chondroplasty.  While this improved the sense of instability in her knee she had ongoing activity-related symptoms.  While there are a number of options to manage chondral lesions this player decided that she would prefer to manage her symptoms by limiting her weight-bearing activity and retiring from football.  She has been able to remain active in other pursuits and is overall comfortable with her knee symptoms.

Anterior cruciate ligament graft re-ruptures are unfortunately relatively common.  In younger patients the lifetime risk of an injury to the graft or contralateral knee is up to 20%.  Unfortunately many players also have an associated injury to the menisci.  While every effort is made to manage the meniscal damage with a meniscal repair, this is not always possible nor always successful.  As this case demonstrates, injuries to the knee increase the likelihood of developing an articular cartilage lesion.

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