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Case Reports
. 2025 Jun:131:111352.
doi: 10.1016/j.ijscr.2025.111352. Epub 2025 Apr 23.

ACL rupture from medial meniscus tear and high tibial slope: Case report

Xu Yunqin  1 , Tang Yong  2 , Deng Pan  2 , Yao Yourong  2 , Wei Qiangqiang  2 , Wang Jianmin  3
Affiliations
Case Reports

ACL rupture from medial meniscus tear and high tibial slope: Case report

Xu Yunqin et al. Int J Surg Case Rep. 2025 Jun.

Abstract

Introduction and importance: Tears in the posterior medial meniscus leading to anterior cruciate ligament (ACL) rupture are rare. While the ACL is the primary structure responsible for anterior knee stability, its function can also be influenced by the medial meniscus and the posterior tibial slope.

Case presentation: We report a case of a patient with a rupture of the posterior medial meniscus accompanied by a significantly elevated posterior tibial slope. Despite undergoing two arthroscopic meniscectomies, the patient failed to recover. Four years postoperatively, the anterior cruciate ligament degenerated and ruptured.

Clinical discussion: We hypothesize that damage to the posterior medial meniscus may increase stress on the anterior cruciate ligament, particularly in the presence of a high posterior tibial slope.

Conclusion: Early surgical repair improved outcomes in medial meniscal posterior horn tears. Tibial slope correction reduced revision rates in patients with >10°tibial slope undergoing ACL reconstruction.

Keywords: Anterior cruciate ligament; Arthroscopy; Case report; Medial meniscus; Posterior tibial slope.

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Conflict of interest statement

Conflict of interest statement All authors had no financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. (Include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding.)

Figures

Fig. 1
Fig. 1
The MRI T2-weighted image showed the anterior cruciate ligament normal upon first admission.
Fig. 2
Fig. 2
The initial admission CT revealed a posterior tibial plateau tilt angle of 13°.
Fig. 3
Fig. 3
The MRI T2-weighted image showed a grade III tear of the medial meniscus posterior horn that did not heal upon the second hospital admission.
Fig. 4
Fig. 4
During the third hospitalization, the MRI showed that the ACL had become thinner and lax, with a decreased angle to the tibial plateau, and there was a high signal shadow present.
Fig. 5
Fig. 5
The MRI T1-weighted image at 3 months post-operation shows changes after anterior cruciate ligament reconstruction with artificial ligament.
Fig. 6
Fig. 6
The initial arthroscopic examination revealed a severe tear in the posterior horn of the medial meniscus.
Fig. 7
Fig. 7
During the first surgery, meniscectomy was performed on the medial meniscus.
Fig. 8
Fig. 8
The second arthroscopic examination revealed a non-healing tear in the posterior horn of the medial meniscus.
Fig. 9
Fig. 9
During the second surgery, posterior horn meniscectomy and repair of the medial meniscus of the right knee was repeated.
Fig. 10
Fig. 10
During the third arthroscopic surgery, intraoperative findings revealed that the posterior horn of the medial meniscus of the right knee was still ruptured and not healed.
Fig. 11
Fig. 11
During the third arthroscopic examination, it was found that the anterior cruciate ligament was lax and torn.
Fig. 12
Fig. 12
During the third surgery, the posterior horn of the medial meniscus of the right knee was repaired.
See this image and copyright information in PMC

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