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This article is the author’s final published version in American Journal of Case Reports, Volume 23, November 2022, Article number e937581.

The published version is available at Copyright © Am J Case Rep,.


BACKGROUND Posterior meniscal root avulsions can cause meniscal extrusion, joint space narrowing, and progressive knee arthritis. Iatrogenic posterior meniscal root avulsions after malpositioning of the transtibial tunnels during anterior cruciate ligament (ACL) reconstruction can account for poor long-term outcomes seen in some patients following ACL reconstruction. Therefore, correct transtibial tunnel placement during ACL reconstruction is essential to avoid iatrogenic meniscal damage. CASE REPORT A 32-year-old man presented with 1 year of right knee pain and instability following a non-contact twisting injury sustained while playing soccer. An ACL tear with no meniscal involvement was diagnosed at an outside institution. A double-bundle reconstruction was performed at that time. Three months after surgery, a medial partial meniscectomy was performed after a medial meniscal tear and failure to reduce initial symptoms during the index procedure. Advanced imaging at our institution 6 months later demonstrated an iatrogenic lateral posterior meniscal root avulsions after malpositioning of the transtibial tunnels. Given the ACL graft integrity upon arthroscopic evaluation, the root tear was repaired using a 2-tunnel transtibial pull-out technique. Advanced imaging 1 year after surgery showed a well-maintained meniscal repair with no extrusion. CONCLUSIONS Accurate transtibial tunnel placement during ACL reconstructive surgery is vital to avoid meniscal root detachment and the associated complications resulting in poor patient outcomes from this iatrogenic injury. Clinicians treating patients with a history of cruciate ligament reconstruction presenting with postoperative pain and instability should consider this pathology in their differential diagnosis.

Conflict of interest statement Conflict of interest: ASV, JL, HS, SG, and KNK have no conflicts of interest. NNV reports being Board or committee member of American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America; research support from Arthrex, Inc., Breg, Ossur, Wright Medical Technology, Inc., Smith & Nephew; publishing royalties from Arthroscopy, Vindico Medical-Orthopedics Hyperguide; editorial or governing board of Knee, SLACK Incorporated; stock or stock options for Cymedica, Minivasive, Omeros; and paid consultant for Minivasive, Orthospace. JC reports personal fees from Arthrex, personal fees from CONMED Linvatec, personal fees from Ossur, and personal fees from Smith & Nephew, outside the submitted work

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