A young female athlete suffered from the residual instability of the knee after anterior cruciate ligament (ACL)\r\nreconstruction with hamstring autograft. The 3-dimensional (3-D) CT scan showed the ââ?¬Å?high noonââ?¬Â positioning of\r\nthe primary femoral bone tunnel. The revision surgery with anatomic double-bundle technique was performed two\r\nyears after the primary surgery and the femoral tunnels were created with the assistance of the 3-D fluoroscopybased\r\nnavigation. An arthroscopic examination confirmed the ACL graft impingement against posterior cruciate\r\nligament (PCL) when the knee was deeply flexed. The histological analysis of the resected primary ACL graft\r\nshowed local inflammatory infiltration, enhanced synovial coverage and vascularization at the impinged site. The\r\nenhanced expression of vascular endothelial growth factor (VEGF) at the impinged area when compared with nonimpinged\r\narea was observed on immunohistochemical analysis. Abnormal mechanical stress by the impingement\r\nagainst PCL might have induced chronic inflammation and VEGF overexpression.
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