Post COVID-19 Anterior Cruciate Ligament (ACL) Tear in Twin Sisters After Re-starting Professional Futsal Exercises: A ‎Case Report

Awareness of the long-term COVID-19 complications is of significant importance in reducing its morbidity through the implementation of timely interventional programs. In this study, we report an anterior cruciate ligament (ACL) tear in athlete identical twin sisters almost 2 months after the COVID-19 infection. The patients had 15 years of professional futsal experience and showed no obvious risk factors for an ACL tear, such as familial history, abnormal menstruation, oral contraceptive consumption, reduced intercondylar notch, or increased tibial slope. However, they experienced a non-contact complete ACL tear within 1 month of re-participation in professional exercise after the COVID-19 infection. Both patients reported a sense of muscle weakness during the COVID-19 recovery period, and ligamentous laxity was obvious according to the clinical examination and the Beighton criteria. This report shows persistent muscle weakness after the COVID-19 infection that could increase the risk of ACL injury in female athletes and suggests taking a prophylactic rehabilitating program to prevent its catastrophic consequences.