Seeing double: a case report on anterior cruciate ligament reconstructions in identical adolescent twins

Abstract

Introduction: The rate of paediatric anterior cruciate ligament (ACL) rupture is increasing and is a significant injury in the immature athlete. There is a trend to early reconstruction, but the ideal surgical technique remains controversial with long-term outcomes unclear. This prospective study evaluates the unique situation of twelve-year-old female identical twins who both sustained right ACL ruptures within twenty-four hours of each other at the same touch football competition. Methods: Two months following ACL injury both twins underwent ACL reconstruction on the same day with the same surgeon, one with a transphyseal double hamstring graft technique and the other with a transphyseal single hamstring TLS augmented graft. Both patients subsequently underwent post-operative rehabilitation with the same physiotherapist, attending appointments concurrently. Radiographic, clinical, and quality of life parameters were assessed following the surgery for up to two years to date. Radiographical measurements included bone age, graft diameter, knee chondral quality and growth plate disturbance. Physical outcome measures included graft laxity, hip and knee range of movement, Y-balance test, double jump test, vertical jump test, forward step down test, single hop for distance test, cross-over hop for distance test, landing error scoring system, and agility tests. Two dimensional motion analysis of functional tests was used for qualitative evaluation. Self-reported function and quality of life were also assessed via the Pedi-FABS, Pedi-IKDC, and KOOS. Results: Both patients had stable knees at follow-up with neither experiencing re-rupture. Radiological findings confirmed an intact graft and there were no growth disturbances in the coronal or axial planes. Both patients had returned to sport. Discussion: For the first time a prospective evaluation of twins who sustained ACL injuries within a twenty-four hour period was conducted. The findings provided insight into surgical management and rehabilitation in the skeletally immature population.L20029020002019-10-01 <br />