Discussion
notchplasty, anterior knee instability, ACL ruptures, pain
RECURRENCE
This study demonstrates that both arthroscopic debridement and complete resection of the ACL lead to improvement of clinical and radiological findings in isolated MDACL. However, complete resection of the ACL will result in higher instability of the knee joint and with debridement the ACL can be partly preserved with almost normal ACL function and healthy ligament fibers in the postoperative MRI.MDACL has been a rare pathological entity because it has been underdiagnosed and confused with other pathologies [In previous studies arthroscopic total and partial excision of MDACL, combined with or without notchplasty, has been found to result in pain relief and improve in the range of motion of the knee [The present study has several limitations. First, the patient population is small. Second, the follow-up period of only 17 months on average is short, because residual anterior knee instability will most probably lead to a higher rate of subsequent ACL reconstruction over a longer follow-up period, mainly in patients with complete ACL resection. Additionally, a higher rate of ACL ruptures in the patients after partial ACL resection could be possible. Further on a longer follow-up period would give information about a possible rate of recurrence of MDACL after partial resection. Lastly, the inclusion criteria were based on clinical and MRI findings without routine histological verification. However, to our knowledge, this is the first controlled study with patients who have an isolated MDACL to evaluate the effect of partial or complete resection in MDACL specifically.