Abstract
Congenital absence of the cruciate ligaments is a rare condition, already described in literature, usually associated with severe malformations or to congenital dislocation of the knee, with a prevalence of 0.017 per 1000 live births.
We report the case of a 15-years-old girl presenting with pain in the medial part of the right knee since about 4 months without traumatism. Our physical examination revealed a marked sagittal laxity. The MRI displayed a ligamentous structure, quite irregular but with a direction consistent with a sort of PCL, but there was no identifiable structure with the iconographic features of the ACL. Arthroscopic images confirmed that the insertion of the ACL was completely empty. The only ligament that we could find was a rough outline of a menisco-femoral ligament. A second bundle, looking like the PCL, was hypoplasic and thin.
This case brought us to think about the processes that lead to the formation of the ligamentous structures of the knee. We believe that the skeletal changes of the intercondylar notch and tibial spine are secondary to the absence of the ligaments.
Our hypothesis is that the PCL is always the first to develop.
The peculiarity of this case was the presence of an outline of the posterior menisco-femoral ligament (Wrisberg). This ligament is a distinct structure, continuous with the posterior horn of the lateral meniscus that goes posterior to the PCL.
Concerning the menisco-femoral ligaments we put forward several hypotheses about their development.
A clinical picture of anterior laxity but no traumatism should always bring us to suspect an agenesis of the cruciate ligaments, sometimes only the ACL. Moreover the natural progression of cruciate ligaments absence is different than the traumatic one, because there are no secondary lesions and degenerative evolution is delayed probably because of the morphological adaptation of the congenitally altered knee.
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Gala, L., Berruto, M., Usellini, E. et al. Agenesia dei legamenti crociati in ragazza di 15 anni. Arch Ortop Reumatol 121, 7–8 (2010). https://doi.org/10.1007/s10261-010-0020-0
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DOI: https://doi.org/10.1007/s10261-010-0020-0