AANA/SOMOS Course Materials (August 2021)-Ligament Surgery Case Presentations

Ligament Surgery Case Presentations

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This document summarizes key ligament surgery case presentations moderated by Drs. McIntyre and Stuart, with a panel including Drs. Joyner, Sgaglione, Bonner, Chahla, and Tokish, focusing on complex knee ligament injuries and repairs.<br /><br />Case 1 involves a 17-year-old female soccer player who sustained an acute non-contact ACL tear with a “pop” and knee swelling. Exam showed Grade 2 Lachman and Grade 3 pivot shift tests, indicating significant ACL laxity. Prognostic factors influencing outcomes include meniscal and cartilage injuries, multiligament involvement, smoking, age, sport type, posterior tibial slope, and laxity. The presentation referenced the STABILITY study, a randomized clinical trial (RCT) with 618 patients averaging 25 years old, which demonstrated that adding lateral extra-articular tenodesis (LET) to hamstring tendon autograft ACL reconstruction reduced failure rates from 11% to 4% at two years.<br /><br />Case 2 involved a 21-year-old Division 1 lacrosse player with two previous ACL reconstructions (hamstring autograft and bone-patellar tendon-bone [BTB] autograft). Six months after revision ACL reconstruction with BTB graft, he had limited knee flexion (0-90 degrees) and MRI was reviewed. Intraoperative findings revealed a hard flexion stop, mild anterior laxity (3 mm Lachman), no pivot instability, and some adhesions. Surgical decision-making focused on graft selection and the merits of revision with autograft resulting in better sports function and 2.78 times lower re-rupture risk. The presentation stressed planning between single- and two-stage revision surgery based on tunnel position, size, and bone stock.<br /><br />Case 3 described a 39-year-old NYPD officer who suffered a traumatic left knee dislocation at work. Initial treatment included repairs and ACL, PCL, and MCL reconstructions, with staged posterolateral corner reconstruction planned later. At nine months postop, he presented with instability, giving way, swelling, pain, and stiffness impairing work.<br /><br />Overall, the cases emphasize individualized assessment, prognostic indicators, graft choice, surgical staging, and strategies to optimize stability and return to sport/work following complex ligament injuries.

Keywords

ligament surgery

ACL tear

knee injuries

lateral extra-articular tenodesis

revision ACL reconstruction

hamstring autograft

bone-patellar tendon-bone autograft

multiligament knee injury

surgical staging

return to sport