Anterior cruciate ligament reconstruction in a patient who has received systemic steroids for autoimmune disease

Abstract

Background: An anterior cruciate ligament (ACL) reconstruction has become more common and the surgical morbidity has decreased, it has been performed not only in younger people to play sports but also middle-aged people, with satisfactory results. Therefore, some patients might have comorbidities for which they take medicines. Especially the medicines, such as systemic steroids, might influence the reconstructed ligament strength and durability.

Case report: A 49-year-old woman who was taking oral steroids for autoimmune hepatitis suffered a spontaneous ACL injury. She complained of unstable symptoms in the knee despite initial conservative treatment. Then, she was treated operatively with autologous hamstring tendon grafts. Three years postoperatively, her knee remained stable with 1.8 mm side-to-side difference on a Kneelax arthrometer and with 1.6 mm on anterior stress radiographs. There was no rerupture or instability.

Conclusion: The patient who had received systemic steroids for a long time recovered satisfactorily after the operation, with achievement of knee stability and possibility to prevent degenerative change in the knee joint. ACL reconstruction should be considered even in patients with such medication.

Fig. 1

Sagittal T2 images show that the reconstructed graft has a homogeneous low-intensity signal indistinguishable from that of the PCL or patellar tendon, and a good integration within the bone tunnel, demonstrating matured ligamentization. The Howell graft signal assessment was grade II¹¹; Grade I designated a zone filled with a graft that had a homogeneous low-intensity signal indistinguishable from that of the PCL or patellar tendon, grade II designated a volume of the graft analyzed on multiple slices of at least 50% of the normal ligament signal intermixed with portions of the graft that had acquired increased signal intensity, grade III designated a graft within a zone that had less than 50% of its volume exhibiting a normal-appearing ligament signal, and grade IV designated a diffuse increase in the signal intensity with no normal-appearing strands of ligament.