Bicruciate knee ligament deficiency is less harmful to the meniscus and chondral tissue than isolated cruciate injuries

Objective

Simultaneous injury to both cruciate ligaments seriously compromises the kinematics of the knee joint. This study aims to retrospectively investigate the incidence of meniscus and chondral injuries and extra-articular injuries in a series of 25 consecutive patients with chronic bicruciate knee ligament injuries managed surgically.

Material and methods

The patient’s mean age was 27.7 ± 5.1, median 28.00 (17.00–37.00), and 80% were male (n = 20). The average injury time to surgery was 12 months (1–96 months). Recorded data on intra- and extra-articular knee injuries were compared between genders, according to age, meniscal and chondral injuries, and mechanism of trauma in 25 patients with bicruciate knee ligament injury. Knee magnetic resonance imaging (MRI) exams were collected and examined.

Results

Meniscal injuries occurred in 40% of patients, with intra-substance signal alteration (grade I and II), meniscocapsular injury or small extension of the injury to the articular surface of the meniscus. No complex meniscal injury or displaced meniscal fragments were observed at MRI and at surgery, with minor chondral injuries or bone bruises.

Conclusion

Bicruciate knee ligament deficiency is less harmful to the meniscus and chondral tissue than isolated anterior cruciate ligament (ACL) tears, suggesting that this injury pattern leads to lower abnormal compression and shear forces on the joint surfaces. It could indicate that the “compass right-arm injury” of the femoral condyle on tibial components (meniscus and chondral tissue) is heightened in isolated cruciate knee ligament injuries, resulting in more complex damage than in bicruciate ligament tears. Given the high-energy trauma involved, extra-articular injuries could take place, and they should be taken into account in surgical decision-making.

Level of evidence IV: Case series.