Skip to main content
SpringerLink
Log in

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

  • Review Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of Data and Materials

The data sets during and/or analysed during the current study available from the corresponding author on reasonable request.

Abbreviations

AC:

Articular cartilage

ACLA:

Anterior cruciate ligament aplasia

ACLR:

Anterior cruciate ligament reconstruction

AL:

Anterolateral

BPTB:

Bone patellar tendon bone

CKD:

Congenital knee dislocation

CORA:

Centre of angulation of rotation

FH:

Fibular hemimelia

ICN:

Intercondylar notch

LCL:

Lateral collateral ligament

LFC:

Lateral femoral condyle

LLD:

Limb length discrepancy

LM:

Lateral meniscus

MFC:

Medial femoral condyle

MFL:

Menisco femoral ligament

MM:

Medial meniscus

MPFL:

Medial patello femoral ligament

PCLA:

Posterior cruciate ligament aplasia

PCLR:

Posterior cruciate ligament reconstruction

PFFD:

Proximal focal femoral deficiency

PFJ:

Patello-femoral joint

PLC:

Postero lateral corner

STG:

Semitendinosis gracilis

References

  1. Johannson, E., & Aparisi, T. (1982). Congenital absence of the cruciate ligaments. A case report and review of the literature. Clinical Orthopaedics and Related Research, 162, 108–111.

    Google Scholar 

  2. Manner, H., Radler, C., Ganger, R., & Grill, F. (2006). Dysplasia of the cruciate ligaments: Radiographic assessment and classification. Journal of Bone and Joint Surgery. American Volume, 88(1), 130–137. https://doi.org/10.2106/JBJS.E.00146

    Article  PubMed  Google Scholar 

  3. Berruto, M., Gala, L., Usellini, E., Duci, D., & Marelli, B. (2012). Congenital absence of the cruciate ligaments. Knee Surgery, Sports Traumatology, Arthroscopy, 20(8), 1622–1625. https://doi.org/10.1007/s00167-011-1816-2

    Article  PubMed  Google Scholar 

  4. Critical-appraisal-tools—Critical Appraisal Tools | Joanna Briggs Institute. Retrieved from https://jbi.global/critical-appraisal-tools. 23 June 2021.

  5. Thomas, N. P., Jackson, A. M., & Aichroth, P. M. (1985). Congenital absence of the anterior cruciate ligament. A common component of knee dysplasia. Journal of Bone and Joint Surgery. British Volume, 67(4), 572–575. https://doi.org/10.1302/0301-620X.67B4.4030852

    Article  CAS  PubMed  Google Scholar 

  6. Kaelin, A., Hulin, P. H., & Carlioz, H. (1986). Congenital aplasia of the cruciate ligaments. A report of six cases. Journal of Bone and Joint Surgery, 68(5), 827–828. https://doi.org/10.1302/0301-620X.68B5.3782255

    Article  CAS  Google Scholar 

  7. Roux, M., & Carlioz, H. (1999). Clinical examination and investigation of the cruciate ligaments in children with fibular hemimelia. Journal of Pediatric Orthopedics, 19(2), 247–251. https://doi.org/10.1097/00004694-199903000-0002

    Article  CAS  PubMed  Google Scholar 

  8. Gabos, P. G., El Rassi, G., & Pahys, J. (2005). Knee reconstruction in syndromes with congenital absence of the anterior cruciate ligament. Journal of Pediatric Orthopedics, 25(2), 210–214. https://doi.org/10.1097/01.bpo.0000153874.74819.29

    Article  PubMed  Google Scholar 

  9. Chomiak, J., Podskubka, A., Dungl, P., Ost’Adal, M., & Frydrychova, M. (2012). Cruciate ligaments in proximal femoral focal deficiency: Arthroscopic assessment. Journal of Pediatric Orthopaedics, 32(1), 21–28. https://doi.org/10.1097/BPO.0b013e31823d34db

    Article  PubMed  Google Scholar 

  10. Sachleben, B., Nasreddine, A., Nepple, J., et al. (2019). Reconstruction of symptomatic congenital anterior cruciate ligament insufficiency. Journal of Pediatric Orthopedics, 39(2), 59–64. https://doi.org/10.1097/BPO.0000000000000940

    Article  PubMed  Google Scholar 

  11. Andersson, A. P., & Ellitsgaard, N. (1992). Aplasia of the anterior cruciate ligament with a compensating posterior cruciate ligament. Acta Orthopaedica Belgica, 58(2), 240–242.

    CAS  PubMed  Google Scholar 

  12. Balke, M., Mueller-Huebenthal, J., Shafizadeh, S., Liem, D., & Hoeher, J. (2010). Unilateral aplasia of both cruciate ligaments. Journal of Orthopaedic Surgery and Research, 5(1), 11. https://doi.org/10.1186/1749-799X-5-11

    Article  PubMed  PubMed Central  Google Scholar 

  13. Benassi, A. B., Guerreiro, J. P. F., de Oliveira Queiroz, A., Gasparelli, R. G., & Danieli, M. V. (2018). Anterior and posterior cruciate ligament agenesis. Journal of Surgical Case Reports. https://doi.org/10.1093/jscr/rjy216

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chahla, J., Pascual-Garrido, C., & Rodeo, S. A. (2015). Ligament reconstruction in congenital absence of the anterior cruciate ligament: A report of two cases. HSS Journal, 11(2), 177–181. https://doi.org/10.1007/s11420-015-9448-6

    Article  PubMed  PubMed Central  Google Scholar 

  15. Davanzo, D., Fornaciari, P., Barbier, G., Maniglio, M., & Petek, D. (2017). Review and long-term outcomes of cruciate ligament reconstruction versus conservative treatment in siblings with congenital anterior cruciate ligament aplasia. Case Reports in Orthopedics, 2017, 1636578.

    Article  Google Scholar 

  16. De Ponti, A., Sansone, V., & de Gama, M. M. (2001). Bilateral absence of the anterior cruciate ligament. Arthroscopy, 17(6), E26. https://doi.org/10.1053/jars.2001.22411

    Article  PubMed  Google Scholar 

  17. Degnan, A. J., Kietz, D. A., Grudziak, J. S., & Shah, A. (2018). Bilateral absence of the cruciate ligaments with meniscal dysplasia: Unexpected diagnosis in a child with juvenile idiopathic arthritis. Clinical Imaging, 49, 193–197. https://doi.org/10.1016/j.clinimag.2018.03.015

    Article  PubMed  Google Scholar 

  18. Figueroa, D., Calvo, R., Villalón, I. E., Schmidt-Hebbel, A., Figueroa, F., & Baar, A. (2012). Single time angular deformity correction and treatment of knee instability in congenital fibular hemimelia. A case report. The Knee, 19(4), 504–507. https://doi.org/10.1016/j.knee.2011.07.009

    Article  PubMed  Google Scholar 

  19. Hejgaard, N., & Kjaerulff, H. (1987). Congenital aplasia of the anterior cruciate ligament. Report of a case in a seven-year-old girl. International Orthopaedics, 11(3), 223–225. https://doi.org/10.1007/BF00271452

    Article  CAS  PubMed  Google Scholar 

  20. Kambhampati, S. B. (2019). Bucket handle horizontal cleavage tear of medial meniscus with congenital deformity—A case report. Journal of Arthroscopy and Joint Surgery, 6(3), 146–148. https://doi.org/10.1016/j.jajs.2019.05.005

    Article  Google Scholar 

  21. Kaplan, D., Jazrawi, T., Capo, J., & Strauss, E. (2017). multiple ligament reconstruction for absent cruciate and a congenital short femur case report and review of the literature. Bulletin of the Hospital for Joint Disease, 75(2), 143–147.

    Google Scholar 

  22. Kwan, K., & Ross, K. (2009). Arthrogryposis and congenital absence of the anterior cruciate ligament: A case report. The Knee, 16(1), 81–82. https://doi.org/10.1016/j.knee.2008.08.004

    Article  PubMed  Google Scholar 

  23. Lee, J. J., Oh, W. T., Shin, K. Y., Ko, M. S., & Choi, C. H. (2011). Ligament reconstruction in congenital absence of the anterior cruciate ligament: A case report. Knee Surgery & Related Research, 23(4), 240–243. https://doi.org/10.5792/ksrr.2011.23.4.240

    Article  Google Scholar 

  24. Lu, R., Zhu, D. P., Chen, N., Sun, H., Li, Z. H., & Cao, X. W. (2019). How should congenital absence of cruciate ligaments be treated? A case report and literature review. World Journal of Clinical Cases, 7(19), 3082–3089. https://doi.org/10.12998/wjcc.v7.i19.3082

    Article  PubMed  PubMed Central  Google Scholar 

  25. Mascarenhas, R., Simon, D., Forsythe, B., & Harner, C. D. (2014). ACL reconstruction in a teenage athlete with fibular hemimelia. The Knee, 21(2), 613–616. https://doi.org/10.1016/j.knee.2013.10.011

    Article  PubMed  Google Scholar 

  26. Murali, J., Monchik, K., & Fadale, P. (2015). congenital absence of the anterior cruciate ligament. American Journal of Orthopedics, 44(8), E283–E285.

    PubMed  Google Scholar 

  27. Park, I.-S., & Kim, S.-J. (2013). Agenesis of the posterolateral bundle of anterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy, 21(3), 596–598. https://doi.org/10.1007/s00167-012-1962-1

    Article  PubMed  Google Scholar 

  28. Patwardhan, S., Sodhai, V., Sancheti, P., & Shyam, A. (2020). Extra-articular tenodesis using autogenous iliotibial band for symptomatic congenital absence of anterior cruciate ligament: A report of 2 cases. JBJS Case Connector, 10(2), e0240. https://doi.org/10.2106/JBJS.CC.19.00240

    Article  PubMed  Google Scholar 

  29. Rayar, M., Bouillis, J., Fraisse, B., Marleix, S., Chapuis, M., & Violas, P. (2011). Discoid meniscus associated with agenesis of the anterior cruciate ligament in an 8-year-old child. Orthopaedics & Traumatology, Surgery & Research, 97(8), 874–876. https://doi.org/10.1016/j.otsr.2011.04.011

    Article  CAS  Google Scholar 

  30. Razi, M., Mazoochy, H., Ziabari, E. Z., Dadgostar, H., Askari, A., & Arasteh, P. (2020). Anterolateral meniscofemoral ligament associated with ring-shaped lateral meniscus and congenital absence of anterior cruciate ligament, managed with ligament reconstruction. Archives of Bone and Joint Surgery, 8(1), 112–116. https://doi.org/10.22038/abjs.2019.14128

    Article  PubMed  PubMed Central  Google Scholar 

  31. Silva, A., & Sampaio, R. (2011). Anterior lateral meniscofemoral ligament with congenital absence of the ACL. Knee Surgery, Sports Traumatology, Arthroscopy, 19(2), 192–195. https://doi.org/10.1007/s00167-010-1199-9

    Article  PubMed  Google Scholar 

  32. Sonn, K. A., & Caltoum, C. B. (2014). Congenital absence of the anterior cruciate ligament in monozygotic twins. International Journal of Sports Medicine, 35(13), 1130–1133. https://doi.org/10.1055/s-0034-1370923

    Article  CAS  PubMed  Google Scholar 

  33. Katz, M. P., Grogono, B. J., & Soper, K. C. (1967). The etiology and treatment of congenital dislocation of the knee. Journal of Bone and Joint Surgery. British Volume, 49(1), 112–120. https://doi.org/10.1302/0301-620X.49B1.112

    Article  CAS  PubMed  Google Scholar 

  34. Bedoya, M. A., McGraw, M. H., Wells, L., & Jaramillo, D. (2014). Bilateral agenesis of the anterior cruciate ligament: MRI evaluation. Pediatric Radiology, 44(9), 1179–1183. https://doi.org/10.1007/s00247-014-2947-7

    Article  PubMed  Google Scholar 

  35. Dejour, H., Neyret, P., Eberhard, P., & Walch, G. (1990). Bilateral congenital absence of the anterior cruciate ligament and the internal menisci of the knee. A case report. Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur, 76(5), 329–332.

    CAS  PubMed  Google Scholar 

  36. Knorr, J., Accadbled, F., Cassard, X., Ayel, J. E., & Sales de Gauzy, J. (2006). Isolated congenital aplasia of the anterior cruciate ligament treated by reconstruction in a 5-year-old boy. Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur, 92(8), 803–808. https://doi.org/10.1016/s0035-1040(06)75949-9

    Article  CAS  PubMed  Google Scholar 

  37. Steckel, H., Klinger, H. M., Baums, M. H., & Schultz, W. (2005). Cruciate ligament reconstruction in knees with congenital cruciate ligament aplasia. Sportverletzung-Sportschaden, 19(3), 130–133. https://doi.org/10.1055/s-2005-858474

    Article  CAS  PubMed  Google Scholar 

  38. Tolo, V. T. (1981). Congenital absence of the menisci and cruciate ligaments of the knee. A case report. Journal of Bone & Joint Surgery, 63(6), 1022–1024.

    Article  CAS  Google Scholar 

  39. Crawford, D., Tompkins, B., Baird, G., & Caskey, P. (2012). The long-term function of the knee in patients with fibular hemimelia and anterior cruciate ligament deficiency. The Journal of Bone and Joint Surgery. British Volume, 94-B(3), 328–333. https://doi.org/10.1302/0301-620X.94B3.27997

    Article  Google Scholar 

  40. Walker, J., Milbrandt, T., Iwinski, H., & Talwalkar, V. (2019). Classification of cruciate ligament dysplasia and the severity of congenital fibular deficiency. Journal of Pediatric Orthopaedics, 39(3), 136–140. https://doi.org/10.1097/BPO.0000000000000910

    Article  PubMed  Google Scholar 

  41. Giorgi, B. (1956). Morphologic variations of the intercondylar eminence of the knee. Clinical Orthopaedics, 8, 209–217.

    CAS  PubMed  Google Scholar 

  42. Hamdy, R., Makhdom, A., et al. (2014). Congenital fibular deficiency. Journal of the American Academy of Orthopaedic Surgeons, 22(4), 246–255. https://doi.org/10.5435/JAAOS-22-04-246

    Article  PubMed  Google Scholar 

  43. Cuervo, M., Albiñana, J., Cebrian, J., & Juarez, C. (1996). Congenital hypoplasia of the fibula: Clinical manifestations. Journal of Pediatric Orthopedics. Part B, 5(1), 35–38.

    Article  CAS  Google Scholar 

  44. Paley, D., & Standard, S. C. (2010). Treatment of congenital femoral deficiency. In S. W. Wiesel (Ed.), Operative techniques in orthopaedic surgery (pp. 1202–1223). Philadelphia: Lippincott Williams & Wilkins.

    Google Scholar 

  45. Mindler, G. T., Radler, C., & Ganger, R. (2016). The unstable knee in congenital limb deficiency. Journal of Children’s Orthopaedics, 10(6), 521–528. https://doi.org/10.1007/s11832-016-0784-y

    Article  PubMed  PubMed Central  Google Scholar 

  46. World Population Prospects-Population Division-United Nations. Retrieved from https://population.un.org/wpp/Graphs/DemographicProfiles/Line/900. 2 Sept 2021.

Download references

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Sri Dhaatri Orthopaedic, Maternity and Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh, 520008, India

    Srinivas B. S. Kambhampati, Nagashree Vasudeva & Anirudh P. S. Kambhampati

  2. Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, PO Limda, Tal Waghodia, Vadodara, 391760, India

    Karthik Vishwanathan

  3. South West London Elective Orthopaedic Centre (SWLEOC), Epsom, UK

    Bobby Anand

  4. Trauma and Orthopaedic Department, Croydon University Hospital, Thornton Heath, UK

    Bobby Anand

  5. Kettering General Hospital NHS Foundation Trust (Affiliated Teaching Hospital: University of Leicester), First Floor, Warren Hill House, Rothwell Road, Kettering, NN16 8UZ, UK

    Dipen K. Menon

Authors
  1. Srinivas B. S. Kambhampati
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karthik Vishwanathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nagashree Vasudeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bobby Anand
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anirudh P. S. Kambhampati
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dipen K. Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SBSK: conceptualized, designed the study, searched the literature, data collection, Risk of bias assessments, data analysis, derivation of results, manuscript writing, revising and final approval. KV: data collection, risk of bias assessments, data analysis, derivation of results, manuscript writing, revising, final approval. NV: data collection, data analysis, manuscript writing, final approval. APSK: data analysis, manuscript writing, final approval. BA: data analysis, manuscript writing, final approval. DM: data analysis, derivation of results, manuscript writing, revising, final approval.

Corresponding author

Correspondence to Srinivas B. S. Kambhampati.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Ethics Approval

Not applicable. As this is a literature search study, ethics committee approval was deemed not required.

Consent to Participate

Not applicable. As this is a literature search study, ethics committee approval was deemed not required.

Consent for Publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 33 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kambhampati, S.B.S., Vishwanathan, K., Vasudeva, N. et al. Management of Anterior Cruciate Ligament Aplasia for the Arthroscopy Surgeons: A Systematic Review. JOIO 56, 1123–1138 (2022). https://doi.org/10.1007/s43465-022-00651-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-022-00651-2

Keywords

Search

Navigation