Prospective study to assess the healing potential of a conservative treatment with fully restored anatomy and function in patients with partially ruptured Anterior Cruciate Ligament (ACL) with no displacement of ligament fibres.
Materials And Methods
From 2009 to 2012, after an initial clinical examination to establish a traumatic lesion of the ACL
IKDC), we selected cases of partial rupture of the ACL with no displacement of ligament fibres using diffusion-weighted MRI. The diffusion-weighted MRI sequences were used to visualise the persistence of continuous ligament fibres (partial rupture) and to locate the ruptured ACL fibres precisely within the post-traumatic oedematous infiltrate of the intercondylar notch. The oedema usually hampers the visualisation of the fibres on conventional MRI sequences.
The patients’ knees were placed in a load-bearing splint for 6 weeks, with an ROM of 30° to 60° flexion. Another clinical examination was performed at 6 weeks with an MRI to check the continuity of the ligament. Progressive rehabilitation of the knee was then started. Ten months after the initial trauma a clinical examination
IKDC), stress radiography with TELOS device (side-to-side differences between the injured and the intact knees) and an MRI were performed to assess the functional status and anatomical aspect of the ligaments. Over 3 years after the traumatic injury the patients were seen again to check their healed ACL and given a clinical examination
IKDC and KT-1000) by two different physicians, a laximetry test by GNRB and a functional evaluation (subjective IKDC, KOOS and Tegner score).
Currently the 12 first cases of partially ruptured ACL with no displacement of ligament fibres have been re-examined over 3 years after the traumatic injury (mean = 4 years and 1 month). These patients are 5 females, 7 males ; ages ranging from 19 to 54, mean 40.4 ; mean time between trauma and diagnosis : 11 days. 11 patients (i.e. 91.7%) showed fully-restored ACL anatomy on distance MRIs. 10 patients (i.e. 90.9%) showed full healing of the ACL : normal or sub-normal clinical examination
IKDC: 3 patients stage A, 7 patients stage B), normal functional assessment (subjective IKDC ranging from 72,4 to 100, mean 87.7 ; TELOS side-to-side differences at 10 months ranging from -2 to 8mm, mean 2,9mm; KT-1000 side-to-side differences at maximum pressure ranging from 0 to 4mm, mean 1.7 mm; items of the KOOS score on average between 84 and 98). A patient (i.e. 9.1%) presented with significant clinical laxity
IKDC stage C) although this had no functional impact (subjective IKDC, KOOS and Tegner). The only failure was a rupture recurrence which occurred 1.5 years after the traumatic injury and that was treated by surgical ligamentoplasty.
With over 3 years follow-up, the preliminary results of our study demonstrate that in cases of partial ACL rupture with no displacement of ligament fibres, a splint-based conservative treatment yielded a lasting anatomical and functional restoration of the ACL. However, such patients must be pre-selected using diffusion-weighted MRI sequences applied to the knee.