title: Reflex extension loss after anterior cruciate ligament reconstruction due to femoral "high noon" graft placement.
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.
authors: Orthopädische Gemeinschaftspraxis, Straubing, Germany. Strobel@ogp.de
authors: M J
authors: MJ
authors: Strobel
authors: R J
authors: RJ
authors: Castillo
authors: A
authors: A
authors: Weiler
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000637:transplantation*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000209:etiology* / Q000601:surgery; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D019637:Orthopedic Procedures / Q000009:adverse effects*; D016059:Range of Motion, Articular; D012086:Reoperation; D012865:Skiing / Q000293:injuries*