Arthroscopic anterior cruciate ligament reconstruction in a patient with multiple hereditary exostoses

Arthroscopic anterior cruciate ligament reconstruction in a patient with multiple hereditary exostoses


  • Hassan Zmerly san Pier Damiano Hospital Faenza (RA)
  • Ibrahim Akkawi Villa Erbosa Hospital - Bologna
  • Rolando Libri San Pier Damiano Hospital - Faenza (RA)
  • Manuela Moscato San Pier Damiano Hospital - Faenza (RA)
  • Valentina Di Gregori San Pier Damiano Hospital - Faenza (RA)


Multiple hereditary exostoses, osteochondromas, anterior cruciate ligament, reconstruction, arthroscopy, graft fixation



Multiple hereditary exostoses (MHE) also known as Multiple Osteochondromas is a rare benign bone tumour disease, characterized by multiple osteocartilaginous masses. The knee is one of the most affected sites. Anterior cruciate ligament (ACL) surgery is the most common and generally most successful surgical knee procedure; however, the association between MHE and ACL reconstruction is very rare and may represent a challenging procedure because of the anatomical anomaly related to presence of multiple masses around the knee. Here, we present a case report of ACL reconstruction in a patient affected by multiple exostoses.

Case report

The patient was a 30-year-old woman affected by MHE, with an ACL tear arising after knee trauma. As the patient complained of pain, swelling and the knee “giving way”, she successfully underwent arthroscopic-assisted ACL reconstruction using quadrupled hamstring tendon grafts, with femoral suspension and double tibial fixations.


Symptomatic ACL tears in a patient affected by MHE should be considered for arthroscopic reconstruction, which requires that particular attention be paid to tendons harvesting, tunnel placement and the choice of graft fixation system, given the presence of multiple masses around the knee


1.Stieber JR, Dormans JP. Manifestations of hereditary multiple exostoses. J Am Acad Orthop Surg. 2005 Mar-Apr;13(2):110-20. doi: 10.5435/00124635-200503000-00004.

2.Wicklund CL, Pauli RM, Johnston D, Hecht JT. Natural history study of hereditary multiple exostoses. Am J Med Genet. 1995 Jan 2;55(1):43-6. doi: 10.1002/ajmg.1320550113.

3.Svantesson E, Hamrin Senorski E, Webster KE, et al. Panther Symposium ACL Injury Clinical Outcomes Consensus Group. Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injury clinical outcomes consensus group. Knee Surg Sports Traumatol Arthrosc. 2020 Aug;28(8):2415-2434. doi: 10.1007/s00167-020-06061-x

4.Park JY, Cho TJ, Lee MC, Han HS. Successful anterior cruciate ligament reconstruction and meniscal repair in osteogenesis imperfecta. Knee Surg Sports Traumatol Arthrosc. 2018 Aug;26(8):2297-2301. doi: 10.1007/s00167-018-4901-y.

5.Di Benedetto P, Buttironi MM, Mancuso F, et al. Anterior cruciate ligament reconstruction: the role of lateral posterior tibial slope as a potential risk factor for failure. Acta Biomed. 2020 Dec 30;91(14-S):e2020024. doi: 10.23750/abm.v91i14-S.10996.

6.Grzelecki D, Szneider J, Marczak D, Kowalczewski J. Total knee arthroplasty with simultaneous tibial shaft osteotomy in patient with multiple hereditary osteochondromas and multiaxial limb deformity - a case report. BMC Musculoskelet Disord. 2020 Apr 13;21(1):233. doi: 10.1186/s12891-020-03245-x.

7.Fernandez-Perez SA, Rodriguez JA Jr, Beaton-Comulada D, et al. Total knee arthroplasty in patients with multiple hereditary exostoses. Arthroplast Today. 2018 May 7;4(3):325-329. doi: 10.1016/j.artd.2017.11.008.

8.Patel BH, Zeegen E, Sassoon A. Accelerometer-Based, Computer-Navigated Total Knee Arthroplasty to Correct a Complex Deformity in a Patient With Multiple Hereditary Exostoses. Arthroplast Today. 2020 Sep 8;6(4):796-802. doi: 10.1016/j.artd.2020.07.042.

9.Tambe DA, Pawaskar AC, Dhole KP, et al Arthroscopic Anterior Cruciate Ligament Reconstruction in a Case of Multiple Osteochondromatosis: A Case Report. J Orthop Case Rep. 2020 Jul;10(4):31-34. doi: 10.13107/jocr.2020.v10.i04.1788.

10.Widner M, Dunleavy M, Lynch S. Outcomes Following ACL Reconstruction Based on Graft Type: Are all Grafts Equivalent? Curr Rev Musculoskelet Med. 2019 Dec;12(4):460-465. doi: 10.1007/s12178-019-09588-w.

11.Dönmez G, Özçakar L, Korkusuz F. Hamstring Injury After Swimming in a Patient With Multiple Hereditary Osteochondromatosis. Clin J Sport Med. 2016 Sep;26(5):e103-4. doi: 10.1097/JSM.0000000000000266.

12.Morita K, Nii M, Koh MS, et al. Bone Tunnel Placement Determination Method for 3D Images and Its Evaluation for Anterior Cruciate Ligament Reconstruction. Curr Med Imaging. 2020;16(5):491-498. doi: 10.2174/1573405614666181030125846.

13.Zaffagnini S, Urrizola F, Signorelli C, et al. Current use of navigation system in ACL surgery: a historical review. Knee Surg Sports Traumatol Arthrosc. 2016 Nov;24(11):3396-3409. doi: 10.1007/s00167-016-4356-y.

14.Pereira VL, Medeiros JV, Nunes GRS, et al. Tibial-graft fixation methods on anterior cruciate ligament reconstructions: a literature review. Knee Surg Relat Res. 2021 Mar 1;33(1):7. doi: 10.1186/s43019-021-00089-0.

15.Watson JN, McQueen P, Kim W, Hutchinson MR. Bioabsorbable interference screw failure in anterior cruciate ligament reconstruction: A case series and review of the literature. Knee. 2015 un;22(3):256-61. doi: 10.1016/j.knee.2015.02.015.




How to Cite

Zmerly H, Akkawi I, Libri R, Moscato M, Di Gregori V. Arthroscopic anterior cruciate ligament reconstruction in a patient with multiple hereditary exostoses. Acta Biomed [Internet]. 2021 Jul. 26 [cited 2024 Jul. 16];92(S3):e2021004. Available from: