Revision Anterior Cruciate Ligament Reconstruction in a Patient with Generalized Joint Laxity and Previously Undiagnosed Medial Collateral Ligament Injury: A Case Report Highlighting Surgical Strategies

Abstract

Background: Revision anterior cruciate ligament reconstruction (rACLR) remains one of the most technically demanding procedures in orthopedic sports medicine, particularly in patients with generalized joint laxity (GJL), unrecognized medial collateral ligament (MCL) injuries, and meniscal pathology. Successful outcomes require meticulous diagnostic assessment, individualized graft selection, and simultaneous management of associated ligamentous and meniscal injuries.

Case Report: We report the case of a 23-year-old man with a history of failed primary anterior cruciate ligament reconstruction (ACLR), who presented with recurrent instability, medial knee pain, and episodes of giving way. Clinical and imaging evaluation revealed GJL, a previously unrecognized MCL rupture, meniscal tears, and tibial tunnel widening. A single-stage rACLR using a quadriceps tendon (QT) autograft, combined with concurrent MCL reconstruction and meniscal repair, was performed.

Conclusion: This case highlights the importance of comprehensive evaluation of medial laxity, GJL, and meniscal pathology in all anterior cruciate ligament (ACL) injuries. rACLR in such complex cases requires anatomy-based, patient-specific planning, careful graft selection, and concurrent management of associated injuries to optimize stability and functional outcomes. Hamstring autografts should be used with caution in patients with joint laxity, and double hamstring harvest is discouraged in combined ACL- MCL reconstruction.