case_images: PMC11412753_01
case_images: Lateral X-ray of a skeletally mature individual demonstrating a positive sulcus sign (red circle) suggestive of acute ACL injury.
case_images: CRIOR2024-2021725.001.jpg
case_images: PMC11412753_01_CRIOR2024-2021725.001.jpg
case_images: fig1
case_images: Radiographs obtained at the office demonstrated closed growth plates as well as a positive sulcus with the lateral femoral condyle (Figure 1).
case_images: T2 MRIs of the patient's left knee demonstrating a complete midsubstance ACL tear on the (A) sagittal view (asterisk) as well as increased signal at the medial meniscal root attachment site (red arrow) on the (B) coronal view.
case_images: CRIOR2024-2021725.002.jpg
case_images: PMC11412753_01_CRIOR2024-2021725.002.jpg
case_images: fig2
case_images: Arthroscopic view from the anterolateral portal of the (a) medial and (b) lateral meniscal root tears and (c) a midsubstance ACL tear.
case_images: CRIOR2024-2021725.003.jpg
case_images: PMC11412753_01_CRIOR2024-2021725.003.jpg
case_images: fig3
case_images: ACL tear (Figures 3(a), 3(b), and 3(c)). Additional pathology included an unstable Grade 2 chondral lesion at the posterior aspect of the lateral tibial plateau (Figure 4).
case_images: Unstable Grade 2 chondral lesion of the lateral tibial plateau.
case_images: CRIOR2024-2021725.004.jpg
case_images: PMC11412753_01_CRIOR2024-2021725.004.jpg
case_images: fig4
case_images: ACL tear (Figures 3(a), 3(b), and 3(c)). Additional pathology included an unstable Grade 2 chondral lesion at the posterior aspect of the lateral tibial plateau (Figure 4).
case_images: Arthroscopic view from the anterolateral portal of (a) the reconstructed ACL using a BTB autograft with suture tape augmentation (asterisk) and of (b) the reduced lateral meniscus following the transtibial repair. Of note, the sutures used to repair the lateral root and the suture tape used for the internal brace of the ACL graft were both fixed distally on the tibia using the same anchor (not pictured).
case_images: CRIOR2024-2021725.005.jpg
case_images: PMC11412753_01_CRIOR2024-2021725.005.jpg
case_images: fig5
case_images: FL). Final fixation of the internal brace and two lateral meniscus root repair sutures was done using a 4.75-mm anchor (BioComposite SwiveLock; Arthrex, Naples, FL) with the knee held in full hyperextension prior to final graft fixation (Figures 5(a) and 5(b)).
case_images: Arthroscopic view from the anterolateral portal demonstrating a reduced medial meniscus following transtibial root repair.
case_images: CRIOR2024-2021725.006.jpg
case_images: PMC11412753_01_CRIOR2024-2021725.006.jpg
case_images: fig6
case_images: FL) again with the knee in full hyperextension. Finally, the three-cinch medial meniscal root repair sutures were fixed outside of their tunnel with the knee held at approximately 40  of flexion using a 4.75-mm anchor (Figure 6).
case_images: Left knee radiographs taken 2 weeks following BTB autograft ACL reconstruction with suture tape augmentation and bilateral transtibial root repairs. (A) AP radiograph of the patient's left knee demonstrating good bone block placement in the femur and tibia as well as good position of suspensory fixation button placement on the outer femoral cortex. (B) Lateral radiograph of the patient's left knee demonstrating well-placed bone grafts in the tibia and patella. TB = tight rope button; BB = bone block; BG = bone graft.
case_images: CRIOR2024-2021725.007.jpg
case_images: PMC11412753_01_CRIOR2024-2021725.007.jpg
case_images: fig7
case_images: Radiographs were obtained during his 2-week postoperative visit which demonstrated good position of the ACL bone blocks and the suspensory fixation button on the lateral femoral cortex (Figures 7(A) and 7(B)).