Arthroscopic findings and intra-articular anomalies in congenital cruciate ligament deficiency

This study aims to evaluate the arthroscopic findings of patients undergoing surgery for congenital cruciate ligament deficiency. Specifically, it investigates the frequency and types of intra-articular meniscal and ligament abnormalities associated with this rare condition, which often presents with knee instability in conjunction with longitudinal limb deficiency.

This prospective case series included 53 knees from 51 patients undergoing surgery for congenital cruciate ligament deficiency over a seven year period at a single tertiary centre. Patient demographics, clinical findings, imaging and surgical outcomes were documented. Preoperative MRI scans were used to assess intra-articular anatomy and arthroscopic findings were recorded, focusing on osseous and meniscal morphology as well as ligament anomalies.

Among the 53 knees, 61% were associated with congenital longitudinal limb deficiencies, primarily fibular hemimelia. The ACL was deficient in all cases, while the PCL was also absent or underdeveloped in seven knees. Meniscal abnormalities were found in 42 knees (79.25%), including atypical shape, abnormal attachments and hypertrophied meniscofemoral ligaments that seemed to have a role in constraining sagittal instability.

Congenital cruciate ligament deficiency presents complex intra-articular anomalies, notably in ligament and meniscal structure. Hypertrophied meniscofemoral ligaments often provide compensatory stability, which can be disrupted by trivial trauma. Arthroscopic assessment is critical in planning reconstruction, especially given the atypical anatomy in these patients.