Department of Trauma and Orthopedic Surgery, University of Witten-Herdecke, Cologne Merheim Medical Center, Ostmerheimerstrasse 200, 51109 Cologne, Germany.
J Orthop Surg Res. 2010 Feb 25;5:11. doi: 10.1186/1749-799X-5-11.
Aplasia of both cruciate ligaments is a rare congenital disorder. A 28-year-old male presented with pain and the feeling of instability of his right knee after trauma. The provided MRI and previous arthroscopy reports did not indicate any abnormalities except cruciate ligament tears. He was referred to us for reconstruction of both cruciate ligaments. The patient again underwent arthroscopy which revealed a hypoplasia of the medial trochlea and an extremely narrow intercondylar notch. The tibia revealed a missing anterior cruciate ligament (ACL) footprint and a single bump with a complete coverage with articular cartilage. There was no room for an ACL graft. A posterior cruciate ligament could not be identified. The procedure was ended since a ligament reconstruction did not appear reasonable. A significant notch plasty if not a partial resection of the condyles would have been necessary to implant a ligament graft. It is most likely that this would not lead to good knee stability. If the surgeon would have retrieved the contralateral hamstrings at the beginning of the planned ligament reconstruction a significant damage would have occurred to the patient. Even in seemingly clear diagnostic findings the arthroscopic surgeon should take this rare abdnormality into consideration and be familiar with the respective radiological findings. We refer the abnormal finding of only one tibial spine to as the "dromedar-sign" as opposed to the two (medial and a lateral) tibial spines in a normal knee. This may be used as a hint for aplasia of the cruciate ligaments.
双侧十字韧带发育不良是一种罕见的先天性疾病。一名 28 岁男性因外伤后出现右膝疼痛和不稳定感前来就诊。提供的 MRI 和之前的关节镜报告除了十字韧带撕裂外没有显示任何异常。他被转介给我们进行双侧十字韧带重建。患者再次接受了关节镜检查，发现内侧滑车发育不良，髁间窝极窄。胫骨显示前十字韧带（ACL）缺失足迹和单个凸起，完全覆盖关节软骨。没有 ACL 移植物的空间。无法识别后十字韧带。由于韧带重建似乎不合理，手术结束。如果要植入韧带移植物，需要进行明显的切迹成形术，如果不是部分切除髁，则需要进行明显的切迹成形术。这很可能不会导致良好的膝关节稳定性。如果在计划进行的韧带重建开始时，外科医生从对侧腿的半腱肌中取出，患者会受到严重的损伤。即使在看似明确的诊断结果中，关节镜外科医生也应该考虑到这种罕见的异常，并熟悉相应的影像学发现。我们将仅一个胫骨棘的异常发现称为“单峰驼征”，而不是正常膝关节中的两个（内侧和外侧）胫骨棘。这可能是十字韧带发育不良的一个提示。
