Reflex extension loss after anterior cruciate ligament reconstruction due to femoral "high noon" graft placement

Arthroscopy. 2001 Apr;17(4):408-11. doi: 10.1053/jars.2001.21821.

Abstract

We describe a rare case of a painful reflex extension loss due to femoral malplacement of an anterior cruciate ligament (ACL) graft in a female high-level athlete. The graft was placed on the femoral site in the "high noon" position combined with a slight medial tibial tunnel placement. The resulting anterior-posterior cruciate ligament impingement near extension caused a persistent functional extension deficit of 20 degrees. Under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a proprioceptive reflex leading to a functional extension loss while the patient is awake. After sacrifice of the graft and subsequent replacement of the ACL, full range of motion was achieved within 2 months. After a 3-year postinjury history of 3 arthroscopies and 2 ACL reconstructions, the athlete reached her preinjury activity level again. This rare cause of a reflex extension loss due to femoral high noon graft placement has not been described previously and should be included as a differential diagnosis when evaluating patients with an extension deficit after ACL reconstruction.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anterior Cruciate Ligament / transplantation*
  • Female
  • Humans
  • Joint Diseases / etiology*
  • Joint Diseases / surgery
  • Knee Injuries / physiopathology
  • Knee Injuries / surgery*
  • Orthopedic Procedures / adverse effects*
  • Range of Motion, Articular
  • Reoperation
  • Skiing / injuries*