Arthroscopic Anterior Cruciate Ligament Reconstruction in a 17-Year-Old Female Athlete with Multiple Hereditary Exostoses Using a Peroneus Longus Autograft: A Rare Case Report

Introduction: Hereditary multiple exostoses, also known as multiple osteochondromas, is a rare genetic disorder marked by the formation of osteocartilaginous outgrowths predominantly near the metaphysis of long bones. The knee is a commonly affected joint. Surgical reconstruction of the anterior cruciate ligament in patients with Hereditary multiple exostoses presents unique challenges due to distorted bony anatomy, posing risks to graft harvesting, tunnel positioning, and fixation. Case Report: We present the case of a 17-year-old female football athlete with symptomatic Anterior cruciate ligament deficiency on a background of Hereditary multiple exostoses. Following persistent instability despite conservative management, she underwent arthroscopic Anterior cruciate ligament reconstruction using a tripled peroneus longus tendon autograft. Special precautions were taken intraoperatively to navigate anatomical distortions and ensure precise tunnel placement while avoiding conflict with osteochondromas. Fixation was achieved using a femoral Endobutton and tibial 'T' button. Conclusion: Anterior cruciate ligament reconstruction in patients with Hereditary multiple exostoses is feasible and can yield excellent functional outcomes when anatomical variations are meticulously accounted for in surgical planning. Peroneus longus graft is a viable option when conventional grafts are compromised or inaccessible due to exostoses.