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Case Reports
. 2021 Mar 17:33:100457.
doi: 10.1016/j.tcr.2021.100457. eCollection 2021 Jun.

A case report of multi-ligaments injury of the ACL-MCL-PT combined with an occult fracture of the posterolateral tibial plateau

Tao Xie  1 , Xiao Han  1 , Shao-Bo Zhou  1 , Liu-Long Zhu  1 , Qi-Fang He  1
Affiliations
Case Reports

A case report of multi-ligaments injury of the ACL-MCL-PT combined with an occult fracture of the posterolateral tibial plateau

Tao Xie et al. Trauma Case Rep. .

Abstract

The anterior cruciate ligament and medial collateral ligament are important static stabilizers of the knee. The patellar tendon is part of the knee extensor mechanism. The injury simultaneously involving these three structures is very rare. This paper reports a case with simultaneous ipsilateral rupture of the anterior cruciate ligament, medial collateral ligament, patellar tendon, and an occult compression fracture of the posterolateral tibial plateau. This injury pattern has not been reported in literature yet. The injury mechanism was hypothesized as a sudden anterior translation and valgus of the proximal tibia when the knee was in high flexion, followed by an eccentric quadriceps' contracture. In the followed management, ruptured medial collateral ligament and patellar tendon were sutured with augment, while the torn anterior cruciate ligament and fracture were treated conservatively. The outcome of the treatment was satisfactory, and no complication was observed. To this combined injury, a comprehensive consideration, including physical examination, multiple imaging examinations, and analysis of injury mechanism, is essential for a full diagnosis and treatment decision. Especially, computed tomography may help to identify an occult or non-displaced fracture, which would be easily misdiagnosed when nothing unusual was found in routine X-rays. In the treatment, it is suggested to perform a selective or step-by-step repair to the damaged structures, rather than an immediate total repair after injury.

Keywords: Anterior cruciate ligament; Medial collateral ligament; Patellar tendon; Tibial plateau fracture.

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Conflict of interest statement

The authors declared that they have no conflicts of interest in this work. We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.

Figures

Fig. 1
Fig. 1
The patella alta was observed from lateral view of radiology, and there was no finding of obvious bony lesion (a, b). The ruptures of the PT, ACL, and MCL were confirmed by the MRI images (c, d). Depression and split of the posterolateral tibial plateau (white arrow) were noted on transverse and sagittal cuts of the CT scan (e, f).
Fig. 2
Fig. 2
Full tear of the PT and MCL (a). The PT and MCL were repaired with suture anchor, and a protection cable was used (b, c). White arrow: medial condyle of femur; Black arrow: tibial tubercle; White star mark: patella tendon stump; Black star mark: MCL stump.
Fig. 3
Fig. 3
The protection cable was removed in three months after primary repair of the ligaments (a, b). The continuity of the PT and MCL was restored (c, d). The ACL healed with cicatrization (e).
Fig. 4
Fig. 4
The function of extension and flexion of the injured leg in one year (a, b).
See this image and copyright information in PMC

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