Single-Stage Anterior Cruciate Ligament (ACL) Reconstruction, Medial Meniscus Root Repair, and Mosaicplasty in Young Patient with Non-contact ACL Injury.

Introduction: Background: The incidence of associated cartilage and meniscal pathology with anterior cruciate ligament (ACL) tears varies widely in the literature. Lateral meniscus posterior root tears (LPRTs) were more likely to occur with an ACL tear than medial meniscus posterior root tears, which were more likely to have concomitant knee chondral defects than LPRTs. The medial femoral condyle is the most common location reported overall; however, lateral femoral condyle defects are also reported in both acute and chronic cases. Repair of meniscal root injuries is the treatment of choice with the aim of restoring joint kinematics, contact pressures, and delaying the development of osteoarthritis. Articular cartilage injury associated with ACL reconstruction possibly has the greatest single effect on long-term subjective outcomes. However, compared with meniscal pathology, the volume of literature focused on treatment of chondral defects in conjunction with ACL reconstruction is significantly inferior. Case Report: A case of 37-year-old male patient presented with pain and instability of the left knee since past 3 month following twisting injury of knee while slipping off stairs. Clinically, he was having medial joint line tenderness, positive Lachman and anterior drawer test, positive grade 2 pivot shift, and full range of motion (ROM) of knee. He underwent arthroscopic ACL reconstruction with semitendinosus graft, medial meniscus root repair by suture pull out technique, and mosaicplasty (2 plug, 6 mm) for medial femoral condyle cartilage defect of size (1.5 × 1.5 cm, International Cartilage Repair Society grade 4). Post-operative knee ROM was started from day 1 and he was kept on non-weight-bearing walking for 6 weeks. He was followed at 1 month, 3 month, and 6 month. Visual analog scale (VAS) score and International Knee Documentation Committee (IKDC) score were recorded at 3 and 6 months. Result: His VAS score at 3 and 6 month was 2 and 0, respectively. IKDC score pre-operative was 34.5 which improved to 86.2 at 6-month follow-up. Conclusion: Single-stage ACL reconstruction along with meniscal and chondral injury repair to be done to achieve good functional outcome. Meniscal root repair also prevents ACL reconstruction failure. Despite these observations, further study is needed to know the complex factors involved in optimizing patient outcomes in the setting of ACL insufficiency with concomitant meniscal or chondral injury.