Knee & Sports Case Board

Multi-ligament knee injury 18 mos s/p BTB ACL in an 18M football lineman (C101037)

  • Knee & Sports
  • - ACL Tear

HPI - The patient is an 18-year-old male high school football player (position: offensive line) who is 18 months s/p RIGHT ACL reconstruction with an ipsilateral BTB autograft who injured his RIGHT knee while playing football. The mechanism of injury was an opposing player landing on the outside of his leg, resulting in a valgus-type, twisting knee injury. The patient was unable to bear weight following the injury and was carted off the field. Examination on the sideline immediately following the injury revealed a positive Lachman's and a grossly positive valgus stress test with the knee in full extension. An MRI revealed complete rupture of the ACL graft and a grade 3 (complete) tear of the MCL. Initial management included a hinged knee brace for 8 weeks in an attempt to treat the MCL tear conservatively. At 8 weeks post-injury, valgus-stress radiographs (XRays shown) showed: Medial grapping LEFT knee = 7mm Medial gapping RIGHT knee = 15mm A CT scan was also done to assess for osteolysis of the tunnels. Maximum tunnel diameters are 13mm (femoral tunnel) and 14mm (tibial tunnel). The position of the femoral and tibial tunnels looks adequate. Full-length standing XRays show neutral alignment.

An MRI one day after injury reveals a complete rupture of the ACL graft and a grade 3 MCL tear, no meniscal pathology. What is your initial management of this patient?

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