# Management of a rare case of anterior cruciate ligament reconstruction in a Paralympic athlete with a transtibial amputation – a case report

## TL;DR

A Paralympic athlete with a leg amputation successfully returned to competition after a modified ACL surgery, marking the first reported case of its kind.

## Contribution

This is the first documented case of ACL reconstruction in a transtibial amputee, demonstrating a novel surgical adaptation.

## Key findings

- The athlete underwent ACL reconstruction using a quadriceps tendon graft, avoiding conflict with his prosthesis.
- The modified surgery allowed the athlete to compete and finish 4th at the Paris 2024 Paralympic Games.
- This case highlights the feasibility of successful ACL reconstruction in transtibial amputees.

## Abstract

Advances in technology, prosthetic components and rehabilitation techniques have improved the quality of life for amputees. Wearing a prosthesis enabled them to participate in sports at a high level. Participating in competitive sports puts them at risk of joint injury. This case describes a disabled professional paralympic athlete with a transtibial amputation who has torn his anterior cruciate ligament (ACL). This patient underwent anterior cruciate ligament reconstruction one year before the Paris 2024 Paralympic Games. Surgery had to be adapted in terms of the patient’s operative position, choice of graft and incisions to limit conflict with the prosthesis. Anterior cruciate ligament reconstruction with an ipsilateral quadriceps tendon graft enabled the patient to return to competition and place 4th in his category at the Paris 2024 Paralympic Games. This is the first case of ACL reconstruction in a transtibial amputee reported in the literature. It highlights a rare and difficult surgical procedure that can yield good results.