Case 3, presented by Gregory S. DiFelice, MD and Jacob Calcei, MD describes an otherwise healthy, 30-year-old-female who presented for a second opinion with complaints of persistent pain and instability in her left knee 5 months after a wakeboarding injury. She ambulated with a normal gait and had normal alignment of her spine and lower extremities. On her knee exam, she was noted to have no effusion, full ROM, and an otherwise normal exam except for a dramatically (3+) positive posterior drawer test. A repeat MRI was obtained (Figures 1 and 2), and confirmed a complete, chronic rupture of the posterior cruciate ligament and medial meniscus posterior root tear with extrusion. Given the patient’s persistent instability and pain in the injured knee, she was offered surgical intervention. Arthroscopic exam confirmed a chronic PCL rupture with detachment of the posterior root of the medial meniscus with extrusion. The PCL was reconstructed with an arthroscopic tibial inlay technique using an Achilles tendon allograft. PCL inlay tightrope fixation was used on the tibia, and a BioComposite interference screw was used on the femur. Reattachment of the posterior horn of the medial meniscus was addressed via an accessory posteromedial portal using a suture anchor technique. Two #2 FiberWire looping sutures were passed through the root using suture passers, and these were affixed to the tibia with a 4.75 BioComposite Swivelock. The medial meniscus was well fixed without extrusion and the patient had full range of motion with a negative posterior drawer test (Figure 3). At one month post-op, gentle range of motion was started along with gradual progression to full weight bearing. The patient progressed nicely. MRI at 3 months after surgery confirmed intact allograft reconstruction of the PCL and repair of the posterior root of the medial meniscus with no extrusion (Figures 1 and 2). She is currently one year post-op, stable (1+ posterior drawer), and has resumed full activities without pain or instability.
Read full case details in Volume 5, Issue 3 of Grand Rounds - Complex Cases.
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