Posterior Decompression and Arthrodesis in Congenital Atlantoaxial Subluxation and Associated Complex Vertebral Artery Anomaly: A Case Report.

INTRODUCTION: Anomalous anterolateral meniscofemoral ligaments (ALMFLs) are rare and underreported anatomical variations that are crucial for knee stability and joint biomechanics. This case report presents two instances of ALMFL, one associated with an anterior cruciate ligament (ACL) tear and the other with congenital ACL absence. These cases are significant as they contribute to the limited body of literature on ALMFL and its management, highlighting the importance of recognizing this anomaly during knee surgeries.

CASE REPORT: The first case involves a 28-year-old female with a torn ACL following a skiing injury. During ACL reconstruction, an ALMFL was discovered, attached to the lateral meniscus but not affecting its function. The second case is a 35-year-old female with a history of a meniscal tear, presenting with knee instability and pain. An ALMFL was identified during surgery, alongside a discoid meniscus and complex meniscal tear. Both patients underwent debridement of the ALMFL, with favorable recovery outcomes.

CONCLUSION: This case report underscores the importance of recognizing ALMFL as a potential anatomical variation during knee surgery. Surgeons should be aware of this structure's presence to avoid misdiagnosis or unnecessary interventions. The management approach of debriding the ALMFL to restore natural knee biomechanics has shown positive results, suggesting a viable strategy for future cases. This report advances our understanding of knee anomalies, specifically in patients with ACL injuries or congenital absence, and highlights the need for personalized surgical approaches in these scenarios.