Arthroscopic Hamstring Autograft Reconstruction for Acute, Partial and Chronic Anterior Cruciate Ligament Tears: a Case Series of Three Patients from a Tertiary Care Teaching Hospital in South India

Abstract

Anterior cruciate ligament (ACL) injury is among the commonest ligamentous injuries of the knee in young adults, and the time that passes between injury and reconstruction largely decides what the surgeon will find inside the joint. We report three patients who underwent arthroscopic ACL reconstruction with semitendinosus and gracilis autograft at a tertiary care teaching hospital in Chennai, India. A 23-year-old woman injured her right knee while dancing and presented three weeks later with an effusion, flexion limited to 50 degrees and a contusion of the posterior lateral tibial plateau on magnetic resonance imaging (MRI); a complete tear was confirmed and reconstructed with a 9 mm graft. A 35-year-old man presented one month after a fall with giving way and a positive anterior drawer test; MRI suggested a partial tear, and arthroscopy confirmed partial disruption together with a chondral defect of the medial tibial plateau that imaging had not shown. His tendons yielded a graft of only 7 mm. A 29-year-old man had lived with an untreated complete tear for three years after repeated native splinting and had developed locking and a complex tear of the anterior horn of the lateral meniscus, which was repaired at the time of reconstruction with a 9.5 mm graft. All grafts were secured with adjustable-loop cortical suspensory fixation, and postoperative radiographs showed satisfactory implant position. These cases show how delay invites secondary meniscal damage, why a symptomatic partial tear may still need reconstruction, and why graft diameter deserves attention when the hamstring tendons are small.