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Why all the fuss about paediatric ACL rupture: isn’t the meniscus much more important?
  1. Nicholas Mohtadi1,
  2. Clare L Ardern2,
  3. Lars Engebretsen3
  1. 1Department of Surgery, University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada
  2. 2Division of Physiotherapy, Linköping University, Linköping, Sweden
  3. 3Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Nicholas Mohtadi, University of Calgary Sport Medicine Centre, Calgary, AB T2N 1N4, Canada; mohtadi{at}ucalgary.ca

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When Ava, a 13-year-old basketball player, tried to change direction quickly to drive past her opponent, her knee buckled and she developed an acute haemarthrosis. Ava saw a general practitioner and a physiotherapist who advised her to ice her knee and regain her motion. She initially improved, obtained an over-the-counter brace and returned to playing basketball. The full extent of her injury was not recognised. Ava had weekly episodes of knee giving way when playing basketball and stopped playing her favourite sport. She continued to have a feeling of instability, swelling and pain with her daily activities.

Four months after her injury, MRI of Ava’s knee confirmed the ACL rupture and a lateral meniscal tear. By the time she had a surgical appointment and an arthroscopy her lateral meniscus was almost absent; nothing separated the lateral femoral condyle and the adjacent tibial plateau (figure 1). We will never know the extent of the original injury to Ava’s lateral meniscus. However, we might suspect that the lack of early and specific recognition of the problem and the subsequent recurrent giving way episodes aggravated meniscal damage.

Figure 1

Lateral compartment of the knee with only a small …

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