1. Age/Gender: 25Female Chief Complaint: Left knee ACL tear with knee recurvatum History of Present Illness: 25 yo female with noncontact twisting injury to left knee MRI : shows isolated ACL tear Xray:Normal Patient wishes to return to aerobics execises Physical Exam: 25 degrees knee recurvatum bilaterally and 135 degrees of flexion. stable to varus and valgus at both 0 and 30 degrees. lachman exam 10 mm ant.displacement Diagnosis: ACL tear with knee hyperextension

2. 1.Need to ACL reconstruction? 2.graft option? 3. At what degree of knee range of motion would you secure ACL graft? 4.Chance of failure?

3. Clin Orthop Relat Res.Clin Orthop Relat Res. 2010 Apr;468(4):1136-41. doi: 10.1007/s11999-009-0961-0. Epub 2009 Jul 7.  Does severity or specific joint laxity influence clinical outcomes of anterior cruciate ligament reconstruction? In patients with knee hyperextension, a bone-patellar tendon- bone autograft provided superior stability and function compared with a hamstring tendon autograft. Our data suggest knee hyperextension predicts postoperative stability and function regardless whether patients have severe generalized joint laxity

4. Case 2 Age/Gender: 21 Male Chief Complaint: Left knee pain and ant. instability History of Present Illness: non contact knee injury on the treadmill MRI : 1. Partial-thickness interstitial tear in the anterior cruciate ligament 2. Grade 1 tear in the posterior horn of the medial meniscus 3. joint effusion Physical Exam: Ant. Drawer test + Lachman :- Pivot shift test:- patient wishes to return to sport

5. partial tear of ACL compromising anteromedial bundle, with intact posterolateral

6. Arthroscopic picture of partial ACL tearing Posterolateral (PL) bundle intact Anteromedial (AM) bundle torn and scarred within notch

7. Risk for progression to complete rupture? Treatment option: 1. Nonoperative Treatment: A. neuromuscular proprioceptive rehabilitation B. functional knee brace 2.Operative Treatment A. biologic (PRP) B. thermal shrinkage C. Reconstruction