Akbar Auliya, Pradana Felais Hediyanto, Timothy Francisco Gilbert
Cibinong Regional Hospital, Bogor Regency, Indonesia; Faculty of Medicine, Institut Pertanian Bogor University, Bogor, Indonesia.
Cibinong Regional Hospital, Bogor Regency, Indonesia.
Int J Surg Case Rep. 2023 Nov;112:108890. doi: 10.1016/j.ijscr.2023.108890. Epub 2023 Oct 1.
Anterior cruciate ligament (ACL) is among the most commonly injured structure in the knee with some also suffering from meniscus injuries. However, an ACL rupture with concomitant injury of the discoid medial meniscus is a very uncommon.
A 30 years-old male patient came with unstable left knee, with no history of locked knee and tender joint line. The Lachman and anterior drawer test were positive with no sign of meniscus involvement. The Magnetic Resonance Imaging (MRI) result revealed ACL rupture and a double PCL sign suggesting a medial meniscus tear. Arthroscopic knee surgery was performed for partial meniscectomy of the torn discoid medial meniscus followed by ACL reconstruction, followed by rehabilitation protocol. Six months after the procedure, patient was able to return to preinjury activities.
Discoid meniscus of the knee is a rare congenital condition, especially at the medial meniscus. Due to its shape, it distributes the stress differently and therefore more prone to injury. Patients may present with complains of medial knee pain, iterative effusion, locking in flexion. Surgical management is appropriate for a torn discoid medial meniscus with type of surgery depends on each case. A bucket-handle type of injury with torn ACL should be managed by meniscectomy followed by ACL reconstruction.
A proper diagnosis of ACL rupture and meniscus injury using arthroscopy is a must. A combination of partial meniscectomy of torn discoid meniscus and ACL reconstruction prevents impingement of the graft therefore reducing the risk of graft failure.
前交叉韧带（ACL）是膝关节最常受损的结构之一，部分患者还伴有半月板损伤。然而，ACL断裂合并盘状内侧半月板损伤非常罕见。
一名30岁男性患者因左膝不稳定前来就诊，无膝关节交锁史，关节线压痛。Lachman试验和前抽屉试验呈阳性，无半月板损伤迹象。磁共振成像（MRI）结果显示ACL断裂及双PCL征，提示内侧半月板撕裂。对该患者进行了关节镜下膝关节手术，切除撕裂的盘状内侧半月板部分，随后进行ACL重建，术后遵循康复方案。术后六个月，患者能够恢复到受伤前的活动水平。
膝关节盘状半月板是一种罕见的先天性疾病，尤其是内侧半月板。由于其形状，它以不同方式分布应力，因此更容易受伤。患者可能出现膝关节内侧疼痛、反复积液、屈曲交锁等症状。对于撕裂的盘状内侧半月板，手术治疗是合适的，手术方式取决于具体病例。ACL断裂合并桶柄状半月板损伤应先进行半月板切除术，然后进行ACL重建。
必须通过关节镜对ACL断裂和半月板损伤进行正确诊断。联合切除撕裂的盘状半月板部分并进行ACL重建可防止移植物撞击，从而降低移植物失败的风险。
