2015 ISAKOS Biennial Congress ePoster #1293
Factors Predicting the Non-Displacement of Ligament Fibres in Full Rupture of the ACL.
Cyrille Delin, MD, Paris FRANCE
Philippe Thelen, MD, Paris FRANCE
Annabelle Wyler, MD, Paris FRANCE
Stéphane Silvera, MD, Paris FRANCE
Jean-Yves Van Den Steene, MD, Paris FRANCE
Paul Legmann, MD, PhD, Paris FRANCE
Dominique Folinais, MD, Paris FRANCE
RIM Maussins-Nollet, Paris, FRANCE
FDA Status Not Applicable
Summary: In case of full ACL rupture, the only extrinsic factors that promote a higher percentage of non-displaced ligamentous fibers, are an MRI performed before 4 weeks after trauma and a splint restricting the knee’s flexion and extension.
Following a previous presentation at the ISAKOS congress 2009, in which we demonstrated the healing capacity of a full rupture of the anterior cruciate ligament (ACL) with no displacement of the ligament fragments, our goal was to assess the factors that promote the non-displacement of the ligament fibres when the ACL is fully ruptured.
MATERIALS & METHOD:
Epidemiological study covering a period of one year, including patients successively as they were referred to our centre (hospital?) for MRI exploration of a traumatic injury of the knee, all of whom presented with a lesion of the ACL on their MRI examination. These patients must not have participated in any study concerning the specific management of ACL lesions.
The MRI examination included standard fat-saturated T1 and T2 sequences with sagittal and axial slice diffusion-weighted sequences. MRI diffusion-weighted sequences yield information whether the ACL is fully ruptured or not and show the position of the ruptured ligament fibers within the post-traumatic oedema. The patients completed a questionnaire on their physical characteristics (age, gender, weight), the medical case history of the injured knee, the type of traumatic injury, the time that elapsed before it was taken care of, how the lesion was managed and the patient’s athletic level before injury. All subjects provided written informed consent.
344 patients (160 females and 184 males) with a lesion of the ACL on MRI examination, were included in the study. Mean age was 34.6 years (range = 13 - 70 years) and the mean time between the traumatic injury and the MRI was 22 days. 249 patients (61.8%) presented with an ACL that was fully ruptured on the MRI and 95 (38.2%) were partially ruptured. In 140 of these 249 cases (56.2%) the ligament fibres remained in position at the top of the intercondylar notch. We found 75% of non-displaced ruptured ACLs in the patients over the age of 51 versus 46% under the age of 35. If the patient had worn a splint to restrict the ROM of the knee in flexion and extension (between 20-30° and 60-70°), this percentage peaked at 83.9%. In the female subjects this percentage was 63.9% versus 49.2% in the male subjects. When more than four weeks had elapsed between the traumatic injury and the MRI examination the percentage of ruptured ACLs was 57.1% versus 40.5% at less than 4 weeks. The mechanism of the injury, Body Mass Index and activities that caused the injury, did not significantly change the proportion of displaced or non-displaced ruptured ACLs.
In case of full ACL rupture, the only extrinsic factors that promote a higher percentage of non-displaced ligamentous fibers, are an MRI performed before 4 weeks after trauma and a splint restricting the knee’s flexion and extension. Suitable initial management of subjects suspected of having a lesion of the ACL thus seems likely to increase the number of non-displaced ruptures of this ligament, which has a high potential to heal spontaneously with suitable conservative treatment (see ISAKOS 2009 and 2015).