Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2019; 7(19): 3082-3089
Published online Oct 6, 2019. doi: 10.12998/wjcc.v7.i19.3082
How should congenital absence of cruciate ligaments be treated? A case report and literature review
Ran Lu, Dong-Ping Zhu, Neng Chen, He Sun, Ze-Hui Li, Xue-Wei Cao
Ran Lu, Dong-Ping Zhu, Neng Chen, Department of Orthopedics, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai 519015, Guangdong Province, China
He Sun, Ze-Hui Li, Xue-Wei Cao, Department of Orthopedics, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Author contributions: Lu R and Zhu DP wrote the paper; Cao XW and Lu R helped to revise the paper; Chen N analyzed the special part of the case; Cao XW, Sun H, and Li ZH were the patient’s orthopedic surgeons.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2013), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xue-Wei Cao, MD, PhD, Chairman, Chief Doctor, Orthopedics, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111, Dade Road, Yuexiu District, Guangzhou 510120, Guangdong Province, China. caoxuewei@126.com
Telephone: +86-15817142443
Received: May 28, 2019
Peer-review started: June 3, 2019
First decision: August 1, 2019
Revised: August 11, 2019
Accepted: August 27, 2019
Article in press: August 27, 2019
Published online: October 6, 2019
Abstract
BACKGROUND

Hypoplasia of bilateral cruciate ligaments is a rare congenital malformation. The diagnosis of such diseases and indications for the various treatment options require further analysis and discussion.

CASE SUMMARY

The patient is a 26-year-old Chinese woman who has been suffering from knee pain since the age of 8 years, 2-3 episodes a year. Three years ago, due to the practice of advanced yoga poses, the frequency of left knee pain increased, requiring prompt medical treatment. Magnetic resonance imaging demonstrated an absence of both anterior and posterior cruciate ligaments of both knees with abnormal posterior tilting of the tibial plateau. Bilateral subluxation of the knee joint was also found, therefore tibial osteotomy was performed. The patient reported at the 24 mo follow-up that the frequency of pain and instability had been reduced and function restored.

CONCLUSION

Osteotomy may be an effective method to treat patients with congenital cruciate ligament deficiency with posterior tibial plateau tilting. The diagnosis of congenital cruciate ligament deficiency shall be based on the combination of patient’s medical history, clinical manifestations, and findings from imaging to avoid possible misdiagnosis. Based on the symptoms, frequency of attacks, and intent of the individual, appropriate treatment options shall be identified.

Keywords: Congenital, Dysplasia, Cruciate ligament, Congenital deformity, Osteotomy, Case report

Core tip: While some articles reported the rare disease of congenital absence of cruciate ligaments, to our knowledge none of them systematiclly reports the published cases and summarizes the characteristics of this kind of disease. . We conducted a literature review that focus on the symptoms and their appear age of the disease. In order to find out the best treatment programs for congenital absence of cruciate ligaments, we also paid great attention to the treatment method of each case. In addition, we concluded a diagnostic process that will help clinicians to decrease the chance of misdiagnosis.