A 48-year-old female professional rower sustained a right knee injury in a motor accident, presenting with pain, swelling, and a range of motion (ROM) limited to 0–90 degrees. Physical examination revealed a positive Lachman test.
Given the results of the MRI performed the day after the trauma, what is your diagnosis? What would be your strategy to manage this case?
- 48-year-old
- Female
- Professional rower
- Amateur gym and tennis player
- Right knee injury in a motor accident: pain, swelling
Visit and physical examination the day after the trauma:
- Swelling
- ROM: 0-90
- Lachman test +
- Pivot shift test n.e.
MRI the day after the trauma
How would you classify this ACL tear?
- ✔️Type 2 Sherman classification
- ✔️Type 2 Van der List MRI classification
Sherman MF, Lieber L, Bonamo JR, Podesta L, Reiter I. The long-term follow-up of primary anterior cruciate ligament repair. Defining a rationale for augmentation. Am J Sports Med. 1991 May-Jun;19(3):243-55
Van der List JP, Mintz DN, DiFelice GS. The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging. Orthop J Sports Med. 2017 Jun 22;5(6):2325967117709966. doi: 10.1177/2325967117709966. PMID: 28680889; PMCID: PMC5484434.
How would you classify this ACL tear?
- ✔️Urgent ACL repair
In this case, an acute ACL repair with internal brace augmentation was decided due to the proximal situation of the tear and the acute management of the lesion.
Monaco E, Mazza D, Daggett M, Marzilli F, Annibaldi A, Carrozzo A, Ferretti A. Acute Primary Repair of the Anterior Cruciate Ligament With Anterolateral Ligament Augmentation. Arthrosc Tech. 2021 May 24;10(6):e1633-e1639. doi: 10.1016/j.eats.2021.03.007. PMID: 34258215; PMCID: PMC8252825
3 weeks post-op
9 weeks post-op
3 months post-op
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