Inverted deltoid posterior cruciate ligament femoral insertion accompanied with medial synovial fold: a case of a complex posterior cruciate ligament anatomical variation recalcitrant to conservative treatment.

PURPOSE: The present study aims to report a symptomatic rare anatomical variation of the posterior cruciate ligament (PCL) that was encountered during arthroscopy. CASE PRESENTATION: A 34-year-old female suffered from dull anterior pain in the right knee, along with stiffness and the presence of an audible click and occasionally locking during deep knee flexion. Physical examination revealed only slight pain during single-leg squatting and mild knee effusion with painful limitation of the last degrees of flexion. Following unsuccessful conservative treatment, knee arthroscopy was performed in which the PCL was found to be hypertrophic, having a broad femoral insertion that almost completely occupied the intercondylar notch and impinged the anterior cruciate ligament. Moreover, the PCL presented a large medial synovial fold that formed a plica inserting to the medial meniscus's posterior horn. Ligamentoplasty was performed by excising one-third of the PCL lateral portion. The PCL medial synovial fold and the plica attaching to the medial meniscus were resected. The patient was allowed to return to full activity when her symptoms resolved, and the knee function was restored, at 5 weeks post-operatively. CONCLUSION: The current study presented a rare and complex anatomical variation of the PCL that was symptomatic and recalcitrant to conservative treatment. Magnetic resonance imaging (MRI) can reveal the variant morphology of the PCL, and arthroscopy provides the definite treatment. This case report may be useful for orthopaedic surgeons and radiologists to consider anatomical PCL variations during differential diagnosis in patients with non-specific clinical presentation and findings.

Isolated posterior cruciate ligament aplasia: a case report.

Congenital absence of the cruciate ligaments is a very rare condition, with most reported cases being related to the anterior cruciate ligament (ACL). Posterior cruciate ligament (PCL) congenital abnormalities have been described as almost always being associated with other anomalies. We present a case of a patient with lateral knee pain and subjective instability sensation after a low-energy trauma secondary to a lateral meniscus tear, with absence of the PCL on MRI examination and thickened meniscofemoral ligaments, with anterior and superior insertion at the femur, in the footprint of PCL. The patient had a menisci repair, without PCL reconstruction. At the 6-month follow-up, the patient did not report any instability symptoms during his daily work and sports activities. There are therapeutic implications in distinguishing a chronic PCL tear from an aplasia, so it is important to detect some signs in imaging that may guide to differentiate them, as there could be differences in the course and thickness of meniscofemoral ligaments, besides the absence of the entire PCL. To our knowledge, this is the first case of PCL agenesis with arthroscopic correlation.

Bilateral absence of the cruciate ligaments with meniscal dysplasia: Unexpected diagnosis in a child with juvenile idiopathic arthritis.

Bilateral agenesis of the cruciate ligaments is a rare congenital anomaly. We report a unique case of a young girl who had congenital short femur and diagnosed with polyarticular juvenile idiopathic arthritis (JIA) and later discovered to have congenital absence of both anterior and posterior cruciate ligaments and meniscal dysplasia in both the knees when MRI was performed at 11 years of age. The MRI was performed to evaluate knee laxity and persistent symptoms despite medical management and multiple steroid injections for arthritis treatment. This patient is one of the youngest with congenital absence of both the cruciate ligaments to be treated with ACL reconstruction. We highlight the unique radiographic imaging manifestations of congenital cruciate ligament agenesis and emphasize the role of MRI to confirm and depict additional intraarticular abnormalities.

Multiple Ligament Reconstruction for Absent Cruciate and a Congenital Short Femur Case Report and Review of the Literature.

Congenital short femur syndrome is a rare condition affecting about 0.017 of every 1,000 births. Patients frequently have ligamentous abnormalities, most frequently aplastic or hypoplastic cruciate ligaments. Advances in limb lengthening procedures have increased movement expectations for these patients, thus necessitating surgical treatment for their ligamentous abnormalities. An individual case is presented, including history, physical exam, and imaging demonstrating both the short femur and absent cruciate ligaments. A surgical reconstruction technique of the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner is described. At 1-year follow-up, the patient had 0° to 135° of ROM. He reported no pain but mild swelling experienced during squatting. His knee continues to be stable in all planes with a grade 1A Lachman exam and a grade 1 posterior drawer with no posterolateral corner laxity.

[Congenital aplasia of cruciate ligaments causing knee osteoarthritis]. / Kongenit korsbåndsaplasi som årsag til gonartrose.

We report a case of a 56-year-old women with severe unilateral osteoarthritis and translation due to congenital aplasia of both cruciate ligaments, which was found during knee arthroplasty surgery. Cruciate ligament insufficiency is a known risk factor in osteoarthritis but is very rarely caused by congenital aplasia and is most often due to trauma. While the patient had several common risk factors for the development of osteoarthritis the congenital aplasia may have contributed significantly in this case of osteoarthritis.

Congenital absence of the cruciate ligaments.

Congenital absence of the cruciate ligaments is a rare condition with a prevalence of 0.017 per 1,000 live births. The most important finding of this study was the presence of a posterior menisco-femoral ligament of Wrisberg with cruciate ligaments agenesia and the hypothesis advanced about the development of the ligamentous structures of the knee. Reviewing the literature, we assume that the congenital anomaly that causes the anatomical defect expresses itself around the 7th to 8th post-ovulatory week. Literature teaches us that the need for a knee replacement seems to be inevitable before or after and during the life of a patient without cruciate ligaments.

Isolated congenital absence of posterior cruciate ligament? A case report.

A rare case of a 28-year-old Asiatic male with the isolated absence of a posterior cruciate ligament is reported. Clinical features, diagnostic steps, therapeutic strategies and follow-up are described. A review of the literature is also presented.

Dysplasia of the cruciate ligaments: radiographic assessment and classification.

BACKGROUND: A common pathologic finding in the knee associated with congenital longitudinal deformity is aplasia of one or both cruciate ligaments. We performed a radiographic analysis to assess the changes in the femoral intercondylar notch and the tibial eminence in relation to the status of the cruciate ligaments. METHODS: Thirty-four knees in thirty-one patients with longitudinal congenital deficiency of the lower limb were evaluated. The cruciate ligaments and the associated abnormalities of the distal aspect of the femur and the proximal aspect of the tibia were evaluated with use of magnetic resonance imaging and a tunnel view radiograph. RESULTS: We differentiated three main types of dysplasia of the cruciate ligaments with typical associated changes. In type I, partial closure of the femoral intercondylar notch and hypoplasia of the tibial eminence are observed and the anterior cruciate ligament is hypoplastic or aplastic. In type II, these findings are accentuated and there is additional hypoplasia of the posterior cruciate ligament. In type III, the femoral intercondylar notch and the tibial eminence are completely absent and there is aplasia of both cruciate ligaments. CONCLUSIONS: We delineated three types of congenital deficiency of the cruciate ligaments and found corresponding morphologic changes of the femoral notch and the tibial eminence, which can be observed on tunnel view radiographs. Thus, the diagnosis and differentiation between aplasia of one or both cruciate ligaments and between congenital and trauma-induced absence of the cruciate ligaments may be made by interpreting plain radiographs.

[Fixed posterior subluxation with lateral rotation of the knee joint caused by congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. Case report and review of the literature]. / Fixierte hintere Subluxations- und Aussenrotationsfehlstellung des Kniegelenks bei angeborener Patellaluxation und Aplasie des hinteren Kreuzbandes. Fallbeispiel und Literaturübersicht.

Congenital dislocation of the patella is very rare. In this anomaly, the patella is dislocated to the side of the lateral femoral condylus and cannot be repositioned manually. Diagnosis is often made by clinical examination and observation of an abnormal gait. We describe the long-term course of treatment in a young girl with fixed posterior subluxation with lateral rotation of the knee joint caused by congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. These anomalies of the knee joint were corrected incrementally. First, recentralization of the patella was performed by open surgery. Subsequently, distraction of the shortened ischiocrural muscles and the posterior capsules and ligaments was conducted. This is the first case to be described, to the best of our knowledge, of a patient with congenital dislocation of the patella in combination with aplasia of the posterior cruciate ligament. We describe the successful treatment of such a fixed posterior subluxation and lateral rotation of the knee joint.

Three-dimensional ultrasound diagnosis of Larsen syndrome with further characterization of neurological sequelae.

Larsen syndrome consists of skeletal dysplasia with multiple joint dislocations and a characteristic facies. The basis of this abnormality is a generalized mesenchymal disorder involving connective tissues. We describe our findings in a woman who was referred at 28 weeks' gestation due to multiple fetal anomalies suspected initially at an 18-week ultrasound examination. On three-dimensional (3D) ultrasound we found the fetus had bilateral genu recurvatum. Further 3D examination at 36 weeks confirmed the lower limb anomaly and revealed facial anomalies that led to the diagnosis of Larsen syndrome. An elective Cesarean section was performed at 38 weeks' gestation to minimize neurological sequelae. Magnetic resonance imaging was performed postnatally and showed pachygyria, colpocephaly and agenesis of the corpus callosum. In this case, 3D ultrasound facilitated the prenatal diagnosis of Larsen syndrome. A careful prenatal investigation for other associated anomalies such as those of the cardiovascular or neurological systems is warranted with this diagnosis. These associated lesions are likely to have a greater impact on prognosis than the classic symptoms of Larsen syndrome and a collaborative approach is necessary to optimize delivery and postnatal management of an affected fetus.

Aplasia of the anterior cruciate ligament with a compensating posterior cruciate ligament.

Aplasia of the anterior cruciate ligament is a rare condition and is usually associated with other abnormalities of the lower extremities. We report aplasia of the anterior cruciate ligament with a compensating posterior cruciate ligament in a 15-year-old boy.