Bilateral simultaneous anterior cruciate ligament rupture and reconstruction

Unilateral anterior cruciate ligament (ACL) reconstructions account for approximately 100,000/year injuries in the USA. Those injuries are frequent and have precise management for restoring knee stability and functionality. Bilateral simultaneous ACL injuries are considered rare in orthopedic sports traumatology and no management guidelines for the reconstruction have been described in the current literature. We report the case of a 46-years-old male individual who presented to our department with a history of trauma in both knees which occurred during soccer games. After physical examination and an MRI scan the patient was diagnosed with bilateral ACL rupture. As bilateral ruptures are rare, there is a lack of guidelines for the management of such cases. In this case we opted for a simultaneous single-bundle ACL reconstruction. An autologous hamstrings graft (semitendinosus-gracilis) was used for the reconstruction. Full range of motion (ROM) was achieved at approximately 6 months after the surgery. Even with a lack of surgery guidelines and management guidelines, a simultaneous single-setting reconstruction showed good outcomes and no complications in the presented case. While both staged and single-setting reconstructions are considered viable in a bilateral injury, risks and benefits regarding the two management alternatives should be clearly explained to the patient, highlighting the postoperative and rehabilitation particularities for each option.