Female Collegiate Soccer Player With Atypical Healing Following ACL Reconstruction: A Level 3 Case Study

PATIENT: Patient is a 19-year-old female collegiate soccer center forward who sustained a Grade III ACL sprain (tear) during practice on April 1, 2023. The patient had no prior history of this knee. On-field evaluation revealed a probable ACL tear with possible meniscus involvement. TREATMENT: Between April 1 and 28, the athlete received daily treatments in the athletic training (AT) facility to modulate pain, decrease swelling, and facilitate range of motion and strength. An MRI performed on April 28 revealed a complete tear of the right ACL. The athlete chose to have isolated ACL reconstruction (quadriceps tendon graft) after the semester (May 9). Following surgery, she followed the surgeon’s ACL rehabilitation protocol at a clinic local to her home. By July, underwent manipulation under anesthesia on July 11. She was scheduled for another MRI on September 23 which revealed hypertrophic scarring behind the patella that could indicate the ACL rubbing or placement was off. OUTCOME: The athlete underwent knee arthroscopy on October 4, 2023. Scar tissue behind the patella was removed; the ACL repair appeared intact. A small bony notch off of the tibia was found to be rubbing on the ACL which was causing bleeding and scar tissue. Following surgery, the athlete could nearly full knee extension immediately. She was placed in a straight-leg immobilizer and crutches for one week, then progressed off of the crutches and into a hinged knee brace 2 weeks post-surgery. She continued gate training and strengthening exercises and was cleared by the teamphysician to start progressing into running by December 2023. CONCLUSIONS: Challenges presented with this case include transfer of care as the athlete traveled home to a different state for the summer months, and additional pain and muscle guarding following manipulation under anesthesia. CLINICAL BOTTOM LINE: Persistent inability to regain ROM could require additional imaging.