Management of Anterior Cruciate Ligament Aplasia for the Arthroscopy Surgeons: A Systematic Review

Srinivas B S Kambhampati; Karthik Vishwanathan; Nagashree Vasudeva; Bobby Anand; Anirudh P S Kambhampati; Dipen K Menon

doi:10.1007/s43465-022-00651-2

Management of Anterior Cruciate Ligament Aplasia for the Arthroscopy Surgeons: A Systematic Review

Indian J Orthop. 2022 May 24;56(7):1123-1138. doi: 10.1007/s43465-022-00651-2. eCollection 2022 Jul.

Authors

Srinivas B S Kambhampati¹, Karthik Vishwanathan², Nagashree Vasudeva¹, Bobby Anand^{3

4}, Anirudh P S Kambhampati¹, Dipen K Menon⁵

Affiliations

¹ Sri Dhaatri Orthopaedic, Maternity and Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh 520008 India.
² Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, PO Limda, Tal Waghodia, Vadodara, 391760 India.
³ South West London Elective Orthopaedic Centre (SWLEOC), Epsom, UK.
⁴ Trauma and Orthopaedic Department, Croydon University Hospital, Thornton Heath, UK.
⁵ Kettering General Hospital NHS Foundation Trust (Affiliated Teaching Hospital: University of Leicester), First Floor, Warren Hill House, Rothwell Road, Kettering, NN16 8UZ UK.

Abstract

Background: Anterior Cruciate Ligament Aplasia (ACLA) is a rare condition which can sometimes remain asymptomatic into adult life. Although the quoted incidence is 1.7 per 100,000 live births, it is higher due to these silent cases and can be encountered by the arthroscopy surgeon doing reconstructive procedure for the ACL. The aim of this study is to get information on clinical presentation, imaging, arthroscopy findings and management of the knee in patients with ACL aplasia through a systematic review relevant to the arthroscopy surgeon in making a decision when they encounter such a case.

Methods: We performed a systematic review of the literature to get information on this condition that may be relevant to the arthroscopy surgeon from PubMed, Ovid full text, Embase and Ovid Medline databases. After exclusions and inclusions, we found 31 articles relevant to the search which included 101 knees.

Results: Most of the publications were case reports due to the rarity of this condition. ACLA is commonly associated with Fibular Hemimelia, Congenital Dislocation of the Knee and Proximal Focal Femoral Deficiency (PFFD). Clinical findings, imaging appearances, other associated findings with ACLA have been listed and management options listed and discussed.

Conclusions: Patients with ACLA are often asymptomatic and arthroscopic reconstruction of the ACL appears to be a viable option in selected symptomatic cases only. The arthroscopic surgeon should be aware of the clinical picture and intraarticular findings of ACLA to recognize the condition and make a decision on the optimal management. Further studies are required to report on long-term outcomes of the condition in terms of secondary osteoarthritis development as well as the procedures performed. We recommend forming a global registry to study and further understand the aspects of this condition.

Level of evidence: 4.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-022-00651-2.

Keywords: Agenesis of ACL; Aplasia of ACL; Congenital ACL deficiency; Congenital absent ACL.

Publication types

Review