Abstract
BackgroundAnatomical variations of the attachment of medial meniscus are a common finding. However, anomalies of the posterior horn are extremely rare. Only two cases of posterior root anomaly have been described prior to the routine use of arthroscopy for evaluation and treatment of meniscal pathology. In this report, we present an anomaly of both the anterior and posterior roots of the medial meniscus that posed both a diagnostic and therapeutic dilemma.Case presentationThe patient is young male soccer player who is currently 16 years of age and began having the atraumatic onset of pain and symptoms that limited performance starting at age 14 and was referred for failure of response to nonoperative treatment. Diagnostic arthroscopy revealed the presence of an anteromedial meniscofemoral ligament whereas the posterior root showed no bony attachment. The radiographic and arthroscopic findings are described. The clinical decision was made after to proceed with observation, reassurance, and gradual return to full activity with physiotherapy guidance.Discussion and conclusionThe absence of injury, the mild complaints reported by the patient, his age, skeletal immaturity, and remaining growth led us to adopt a conservative approach to treating this anatomic variant and currently the patient is able to participate fully in sports without symptoms or restrictions.
Highlights
Anatomical variations of the attachment of medial meniscus are a common finding
We present the first report of an anomaly of both the anterior and posterior roots of the medial meniscus, documented by Magnetic resonance imaging (MRI) and confirmed by arthroscopy
Diagnostic arthroscopy was performed secondary to failure of nonoperative management and revealed a white rounded band that was noted to extend from the anterior horn of the medial meniscus to the intercondylar notch adjacent to the femoral insertion of the anterior cruciate ligament (ACL) (Fig. 3A)
Summary
There were two different challenges that needed to be addressed in treating this patient. In 1998, Bhagava and Ferrari [5] described a case of an anomalous band from the posterior horn area of the medial meniscus to insert into the midportion of anterior cruciate ligament. For this particular patient, the main problem we faced was the choice of treatment given the intermittent symptoms. In our particular case, where a combined anomaly of both horns was present, the AMMFL was the only meniscal attachment To remove this isolated fibrous insertion could potentially increase hypermobility of the medial meniscus and be counterproductive. Anteromedial meniscofemoral ligament of the anterior horn of the medial meniscus: clinical magnetic resonance imaging, and arthroscopic features. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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