AANA Lab Course 913 - Advanced Knee Course-State of the Art in Treating ACL Injuries_ What Would You Do

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This document presents multiple illustrative cases of anterior cruciate ligament (ACL) injuries involving active individuals, highlighting diagnostic findings, treatment considerations, and outcomes.<br /><br />Case 1 involves a 26-year-old male ER nurse with a history of vigorous activity and repeated ACL tears beginning at age 20. He underwent two ACL reconstructions using autografts (quadrupled semitendinosus then bone–patellar tendon–bone) and had a medial meniscectomy. Despite surgeries, he experiences instability during cutting and twisting movements with mild medial knee pain. Physical exam shows mild laxity and tenderness; radiographs are discussed but details are not given. The panel debates additional imaging, considering tibial plateau leveling osteotomy (TPLO), type and staging of revision surgery, and medial meniscal allograft transplantation.<br /><br />Case 2 features a 41-year-old female aggressive skier with a recent low-speed injury causing a proximal ACL tear confirmed by MRI. Examination reveals limited range of motion, moderate effusion, and instability on Lachman testing. Treatment options discussed include primary repair, allograft or autograft reconstruction, or non-operative management with physical therapy and bracing. After six months, despite a deep vein thrombosis (DVT) and factor V Leiden, she is asymptomatic with negative stability tests, suggesting possible healing of the ACL, raising the question of management next steps.<br /><br />Additional cases include a 25-year-old novice skier with a complete ACL tear and meniscal injuries requiring arthroscopic meniscal repair; subsequent ACL reconstruction with a hamstring autograft was planned once extension improved. A final case highlights a 22-year-old female college soccer player with acute locking and limited motion after an ACL injury, emphasizing the need for thorough assessment in acute ligament injuries.<br /><br />Overall, these cases underscore the complexity of ACL injury management, considering patient activity level, injury chronicity, associated meniscal pathology, and individualized surgical planning including graft choice, staging, and possibly adjunctive procedures like meniscal allograft or osteotomy.

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Panel: Sgaglione, LaPrade, Bonner, Weber, Alaia, Geeslin, Chahla, McMillan, Shelton
Moderator: John C. Richmond, MD, Darren L. Johnson, MD

Keywords

anterior cruciate ligament

ACL injury

ACL reconstruction

autograft

allograft

meniscal injury

meniscectomy

tibial plateau leveling osteotomy

arthroscopic meniscal repair

ligament instability