2019 ISAKOS Biennial Congress ePoster #829
Predictive Factors for Conservative Treatment Failure When Treating Partial ACL Tears in Young Patients
Mathieu Thaunat, MD, Lyon, Auvergne Rhône Alpes FRANCE
Geoffroy De Montmarin, md, Lyon, Rhône FRANCE
Goran Vrgoc, MD, Zagreb, Croatia CROATIA
Padhraig O'loughlin, MD, Dublin IRELAND
Benjamin Freychet, MD, Rochester, MN UNITED STATES
Bertrand Sonnery-Cottet, MD, PhD, Lyon, Rhône FRANCE
Jean-Marie Fayard, MD, Lyon, Rhône FRANCE
Centre Orthopédique Santy, Lyon, Rhône, FRANCE
FDA Status Cleared
Summary
The most significant finding in the current study was that patient age less than or equal to 20 years and participation in pivot contact sports are significant predictive factors for failure of conservative treatment i.e. progression to a complete ACL tear. This occurred in 39% of this particular cohort, in the current study, at a mean of 43 months, post-injury.
Abstract
Background
Isolated ACL tears account for nearly half of all knee ligament injuries and primarily affect young and active patients. Partial ACL tears are difficult to diagnose and there is currently no consensus on treatment protocols.
Hypothesis/Purpose: The purpose of this study was to assess predictive factors for conservative treatment failure after partial ACL tear in young and active patients.
Study Design: Case series
Methods
Forty-one patients, all less than 30 years of age and active in sports, were diagnosed with a partial ACL tear with no associated meniscal or chondral lesions. All were assigned a conservative treatment programme. Lachman test, Rolimeter® and magnetic resonance imaging (MRI) were utilised for diagnosis. Tegner and IKDC scores were assessed pre-and post-injury, and ACL-RSI at last follow-up.
Results
The partial ligamentous injury progressed to a complete ACL tear in 16 (39%) patients. In the remaining 25 patients, mean Tegner/IKDC scores were respectively 7.0/96.0 pre-injury, and 5.9/85.7, at last follow-up. The mean ACL-RSI was 69.3. Tegner and IKDC scores were significantly lower post-injury. Only 18 (51.4%) patients returned to their pre-injury level of sports activities. Patients under 20 years and practising pivot-contact sports had a statistically significant risk for progression to a complete ACL tear OR 0.19, p=0.037 and OR 6.29, p=0.026). Meniscal lesions were found in 8 (57%) patients with a complete ACL tear.
Conclusion
Young patients (=20 years) practising pivot contact sport after partial ACL tear are at significant risk for progression to complete ACL tear, despite conservative treatment. Surgical treatment may be warranted in young patients who desire to return to pivot contact sports at the same level as prior to partial ACL rupture.