This 40-year-old male football player with a history of an ACL reconstruction with BTB autograft and medial and lateral meniscal repairs presented two years after his surgery. He described an “awkward movement” while walking with his knee in mid flexion resulting in a subsequent giving way sensation associated with immediate pain and swelling. His knee became locked in flexion making him incapable of ambulating without a crutch. Prior to this injury, he recalled no complaints of knee pain or recurrent instability for the past two years.
An x-ray series of the knee was largely normal (not shown). A subsequent MRI scan showed a viable (Howell grade II), well tensioned ACL graft on the sagittal images. A medial meniscal tear was also seen on the sagittal images. The axial and coronal images (shown here) showed a bucket handle tear of the medial meniscus. 3D CT scan reconstructions of the femur and tibia showed correct positioning of the femoral and tibial tunnels of the ACL graft.
On arthroscopic evaluation, the recurrent medial meniscus bucket-handle tear was visualised. The lateral meniscus was intact and stable with the previously repaired tear considered healed upon testing. The ACL graft was well tensioned and competent. An economical partial medial meniscectomy was performed due to the complex nature of the recurrent bucket-handle tear. At two months postoperatively, the patient showed a very good outcome in terms of knee stability, pain and range of motion. He was able to return to normal activities
A failed repair is one of the possible complication of meniscal repair surgery. In older patients it is rare to be able to repair meniscal tears. Most patient with isolated meniscal tears are treated with a partial meniscectomy. Repairing the meniscus is often possible when it is combined with an ACL reconstruction. Although the patient had no complaints of pain, swelling or mechanical symptoms for two year post-operatively, there is a high chance that the previously repaired medial meniscus tear didn’t heal properly after the initial surgery. This could be due to a variety of factors including insufficient quality of the repair, poor tissue quality of the medial meniscus, complexity of the initial tear and persistence of an anteroposterior and/or a rotatory instability. A failed repair should be considered when a patient presents with locking, catching or instability symptoms after surgical treatment.
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