A 24 year old otherwise healthy male presented with a chief complaint of giving way in the left knee. MRI reported complete anterior cruciate Ligament (ACL) tearing. Arthroscopy showed ACL agenesis, ring-shaped lateral meniscus, and an anomalous thick band extending from the anterior horn of the lateral meniscus to the intercondylar notch of the lateral femoral condyle, which is known as the anterolateral meniscofemoral Ligament (MFL). The MFL was attached to the anatomic site of anteromedial bundle of ACL. ACL reconstruction surgery was performed using central 1/3 bone tendon bone graft. Practitioners should be aware that ACL reconstruction in lateral meniscofemoral Ligament with associated ACL agenesis is a treatment option in which the preservation of MFL, as the stabilizer of anterior horn of lateral meniscus, should be considered during ACL reconstruction.

Background: Multi-Ligament knee injury is common after knee dislocation. There are different approaches for treating multi-Ligament knee injuries; however, choosing the best approach is a challenging issue. Objectives: This study aimed to investigate the efficacy of early reconstruction of collateral Ligaments and delayed reconstruction of cruciate Ligaments in multi-Ligament knee injury. Methods: In this prospective study, 24 patients who had a grade 3 tear in one collateral Ligament in addition to tears in two other knee Ligaments were enrolled. At the first stage, collateral Ligaments were reconstructed; after the patient gained full range of motion, reconstruction was done for the cruciate Ligaments. Patients were followed-up for one year and postoperative evaluations were conducted through clinical tests, International Knee Documentation Committee scores, and Lysholm scales. Results: Twenty-four patients were entered into the final analysis. Synchronous injury of anterior cruciate Ligament, posterior cruciate Ligament, medial collateral Ligament, posterior oblique Ligament, posterolateral corner, and lateral collateral Ligament had the highest frequency (37. 5%). At the one-year follow-up, the average Lysholm and IKDC scores were 86. 4 ± 3. 5 and 83. 8 ± 4, respectively. Range of motion was normal in all patients at the end of the study. Furthermore, in varus and valgus stress tests, the outcomes of reconstruction were better on the lateral side of the knee than on the medial side. Conclusion: The results revealed that a two-stage surgery consisting of early reconstruction of collateral Ligaments and delayed reconstruction of cruciate Ligaments have good clinical and functional outcomes in multi-Ligament knee injuries.

The posterior cruciate Ligament (PCL) is the largest and strongest Ligament in the human knee, and the primary posterior stabilizer. Recent anatomy and biomechanical studies have provided an improved understanding of PCL function. PCL injuries are typically combined with other Ligamentous, meniscal and chondral injuries. Stress radiography has become an important and validated objective measure in surgical decision making and post-operative assessment. Isolated grade I or II PCL injuries can usually be treated non-operatively. However, when acute grade III PCL ruptures occur together with other Ligamentous injury and/or repairable meniscal body/root tears, surgery is indicated. Anatomic singlebundle PCL reconstruction (SB-PCLR) typically restores the larger anterolateral bundle (ALB) and represents the most commonly performed procedure. Unfortunately, residual posterior and rotational tibial instability after SB-PCLR has led to the development of an anatomic double-bundle (DB) PCLR to restore the native PCL footprint and co-dominant behavior of the anterolateral and posteromedial bundles and re-establish normal knee kinematics. The purpose of this article is to review the pertinent details regarding PCL anatomy, biomechanics, injury diagnosis and treatment options, with a focus on arthroscopically assisted DB-PCLR.