Partial ACL Ruptures Research Articles

Conservative Rehabilitation of Partial Anterior Cruciate Ligament Tear - A Case Report

The anterior cruciate ligament is one of the most important ligaments in the knee joint (ACL). The ACL is necessary for appropriate knee joint mobility and mechanics. When the ACL is torn, patients may experience issues with their knee's function, as well as instability and the sensation of 'falling away' while walking. The anterior cruciate ligament acts as a main restraint on tibia-to-femur translation (anterior shear). Depending on the angle of knee flexion, this function is allocated to either anteromedial or posterolateral bundle. When the knee is fully extended, the posterolateral bundle is tense; however, when the knee flexes, the posterolateral bundle loosens and the anteromedial bundle tightens.
 We report the case of a 32-year-old man who twisted his leg while jogging, resulting in a partial thickness ACL rupture and mild joint effusion along the periarticular surface of the right knee, as revealed by radiological symptoms and MRI.Conservative rehabilitation in a patient aged 32 year shows good results and so the surgery was not performed. Initially 10 weeks protocol was managed in hospital under the guidance of a therapist including strengthening, stretching and conditioning of lower limb muscles, later on as pain reduced and patient achieved functional pain free range 12 week protocol was further set for home program.

Association of specific meniscal pathologies and other structural pathologies with self-reported mechanical symptoms: A cross-sectional study of 566 patients undergoing meniscal surgery

ObjectivesWe explored associations between specific meniscal pathologies and other concurrent structural knee pathologies with presence of self-reported mechanical symptoms in patients undergoing meniscal surgery. DesignCross-sectional study. MethodsWe included patients undergoing surgery for a meniscal tear from Knee Arthroscopy Cohort Southern Denmark (KACS). Pre-surgery, patients completed online questionnaires including self-reported presence of mechanical symptoms. At arthroscopy, surgeons recorded information about specific meniscal pathologies and other concurrent structural knee pathologies. Relative risks (RR) were estimated to assess associations between specific meniscal pathologies and other structural knee pathologies with preoperative mechanical symptoms from multivariable logistic regression. Results566 of 641 patients (mean age 48.6[SD 12.9] years, 57% men) with complete data were included. 386 (68%) patients reported mechanical symptoms of knee catching/locking and/or extension deficit. Most evaluated joint pathologies were not associated with mechanical symptoms of any kind with RRs close to 1.0. Meniscal tears involving both the posterior and anterior horn (n=22) were associated with knee catching/locking (RR: 1.49[95%CI:1.15–1.93]), and a tear in both menisci (n=49) was associated with extension deficit of the knee (RR: 1.32[95%CI:1.01–1.73]). A partial (n=29) and total ACL rupture (n=37) were each associated with extension deficit (RR: 1.83[95%CI:1.47–2.28] and RR: 1.44[95%CI:1.05–1.98], respectively). ConclusionsLimited associations between specific meniscal pathology and other concurrent knee joint pathologies with presence of self-reported mechanical symptoms were found in patients undergoing meniscal surgery. The findings question the clinical importance of mechanical symptoms as an indicator for arthroscopy for specific meniscal tears with the specific aim to relieve such symptoms.

Intra-ligamentary autologous conditioned plasma and healing response to treat partial ACL ruptures.

Conservative treatment of partial ACL ruptures is associated with a high failure rate, and often patients undergo ACL reconstruction. ACL preservation by trephination of the ACL origin and application of Autologous Conditioned Plasma (ACP) seems to be an intriguing new treatment option to favour ACL tissue healing and avoid traditional reconstruction. The aim of this study was to describe the mid-term outcomes of this new ACL preserving technique. Twenty-four patients (mean age 41.8years) affected by partial rupture of one or both ACL bundles were included in the present trial. The partial ACL tears were arthroscopically assessed and classified according to a new five step grading system. All patients were treated by trephination of the femoral ACL stump and intra-ligamentary application of ACP. The postoperative outcome was evaluated by both subjective scores and stability testing up to a mean of 25.1 months' follow-up. Adverse events and failure rate were also documented. Clinical outcome was good to excellent with IKDC subjective 82.7 (SD 11.8), Lysholm 87.6 (SD 8.1), Tegner 5.3 (SD 2.1), Cincinnati 88.7 (SD 14.8). The failure rate (i.e. persisting knee instability assessed clinically or by rolimeter) was 12.5%. At objective measurements, knee joints showed a firm endpoint in Lachman test, negative pivot shift phenomenon and a significant reduction in AP-laxity compared to pre-operative status by rolimeter testing (p = 0.002). Return to sport practice was achieved after mean 4.8 months (SD 4.1). ACL stump trephination and concomitant intra-ligamentary application of ACP revealed promising results at mid-term follow-up to treat partial ACL lesions.

The difference in the pattern of joint damage in knee osteoarthritis in knees with partial and complete ACL ruptures

The difference in the pattern of joint damage in knee osteoarthritis in knees with partial and complete ACL ruptures

Augmentation technique for partial ACL ruptures using semitendinosus tendon in the over-the-top position

The aim of this study is to present a surgical augmentation technique for partial ACL ruptures in which an isolated, autologous, double-bundle semitendinosus tendon graft is passed over the top of the femur, thus fully preserving the still-intact fibers of the ligament remnant. Between 1992 and 2006, 24 patients underwent ACL semitendinosus autograft reconstruction and were followed up for at least 2 years. The median follow-up was 6.2 years (2-15.6). At the last follow-up examination, the patients were evaluated using the International Knee Documentation Committee scale. Subjective and functional parameters were assessed using the Tegner activity scale and the Lysholm scale. Instrumental evaluation was carried out using the KT-1000 instrument. Sixteen of the 24 patients achieved an IKDC score of A. Of the remaining eight patients, six achieved an IKDC score of B, one an IKDC score of C, and one an IKDC score of D. According to the Tegner activity scale, the median pre-injury sports activity level was seven (5-9) and the median post-injury level was six (4-9), while the mean Lysholm scale score was 95 (90-100). Clinical and biomechanical studies have shown that reconstruction techniques that address both bundles of the ACL provide better rotational stability than techniques that address only a single bundle. Therefore, it seems logical than in patients with a partial rupture of the ACL, the intact bundle could be preserved and only the torn bundle would need to be reconstructed.

Follow-up of Posttraumatic Ligamentous and Meniscal Knee Lesions Detected at MR Imaging: Systematic Review

To perform a systematic review of the literature regarding the natural course of ligamentous and meniscal knee lesions detected at magnetic resonance (MR) imaging. The MEDLINE database was searched from January 1966 to February 2003. Studies were included if all of the following criteria were met: patients had collateral ligament, cruciate ligament, or meniscal lesions; MR imaging was performed in all patients; study included a group and/or subgroup of patients who underwent conservative treatment during follow-up; patients returned to the clinic for follow-up and clinical data or MR imaging outcomes were noted; and article was written in English, Dutch, German, French, Spanish, Italian, Swedish, Danish, or Norwegian. The quality of each study was assessed by using a standardized criteria set, and kappa statistics were used to grade the level of agreement between the two reviewers. Studies with quality scores of 8 or more were designated as high quality. Results were compared with regard to study design and quality scores. The literature search identified 649 articles, and 11 studies (five on posterior cruciate ligament [PCL] injuries, five on anterior cruciate ligament [ACL] injuries, and one on meniscal injuries) met the inclusion criteria. No studies on the follow-up of collateral ligament injuries were identified. Four studies were of high quality, and the kappa value for quality items was 0.80. Between 77% and 93% of the partial or complete PCL ruptures regained continuity. In cases of partial or total ACL rupture, repair of continuity was also possible. A possible association between MR imaging continuity and clinical stability was identified. The ACL and PCL can regain continuity after partial or complete rupture. On the basis of this review, no conclusions can be drawn about the natural course of meniscal or collateral ligament injury seen at MR imaging.

A Modeling Study of Partial ACL Injury: Simulated KT-2000 Arthrometer Tests

A partial ACL injury may involve different levels of fiber disruption, orfibers may sustain microscopic changes in their structure without gross disruption, resulting in a change in ligament function. The effect of partial ACL tears on the mechanical and functional stability of the knee has not been well documented, in part because of diagnostic difficulties. A computer model of the knee in the sagittal plane was used in this study to simulate tests using the KT-2000 Knee Arthrometer, which quantifies Lachman's test for ACL injury. A variety of partial ACL anterior and posterior bundle injuries were simulated. Anterior and posterior bundle injuries were subdivided into four different simulated injury levels: mild (one-half tear of the bundle), moderate (complete tear of the bundle), severe (complete tear of the bundle and tear of one-half of the other bundle), and more severe (severe injury plus an additional elongation of the other bundle represented by 5% increases of its initial strain). Force-displacement results obtained from simulated KT-2000 knee arthrometer tests depended on the level of injury. Mild and moderate injuries produced only small change in the anterior tibial translation--at different force levels. Severe injury produced increased anterior tibial translation depending on which bundle was completely ruptured. The compliance index defined as the ratio of the displacement and the force within 68 N and 90 N anterior drawer forces, the stiffness, and the rate of change of stiffness of the anterior force-displacement were found to be better at predicting partial ACL ruptures than simple differences in anterior tibial translation. It was possible in the model results to discriminate knees with various levels of partial ACL injuries using the first and second derivatives of the force-displacement curve.

Diagnosis of knee instability using sonography

Objective. A sonographic method has been developed to diagnose knee joint instabilities and to gain exactly quantifiable and reproducible measurements. Design. Based on biomechanical considerations, a new positioning device to analyse knee instabilities sonographically has been developed and tested in in vivo studies. Background. Common instrumental testing techniques are difficult to reproduce and show a lack of reliability. Method. Using sonography the cortical line of the femur and tibia are observed. At the same time a translation of these two partners at the knee joint is provoked in a defined position using the special holding device and under a defined amount of stress. Using this method 142 healthy people, placed in different age groups, were tested to establish standard values for the physiological knee joint translation. A prearthroscopic stability analysis was performed on 101 patients. Results. This study proves that the special device developed, together with the technique used, provides reliable and exact measurements for knee instability in different translation directions. In healthy subjects the lateral compartment always showed a larger translation than the medial compartment. A gradual increase in translation was determined in the age groups over 30 years. A significant difference of 0.0001 was shown between knee stability and instabilities. Moreover, a further differentiation between partial and total ACL ruptures and chronic instabilities was determined. This provides an important advantage not offered by usual instrumental testing techniques. Conclusions. The ability to diagnose even a very low extent of instability and to differentiate between different kinds of instabilities enables exact controls to be carried out for both conservative and operative treatment.

Secondary damage to the knee after isolated injury of the anterior cruciate ligament

Between 1978 and 1984, we examined and performed arthroscopy on 1000 consecutive patients. Ninety-eight of the 1000 had isolated ACL damage. These cases do not include patients with initial ACL injuries combined with other intraarticular damage. Diagnosis was by physical and arthroscopic examination. Examination took place an average 13.6 months after injury. Of the 98 isolated ACL injuries, 56 were complete ruptures and 42 were partial ruptures. In most cases of partial rupture, the clinical diagnosis was wrong. "Meniscal damage" was the usual diagnosis in these cases; the true diagnosis was made only by arthroscopic examination. Thirty-four of the 98 patients with isolated ACL injuries (30 men and 4 women) developed further intraarticular damage. Of these 34, 20 had complete ACL rupture and 14 had partial ACL rupture. Treatment after primary injury included physiotherapy in all patients and bracing in those whose knee was unstable during daily activities. Reconstructive surgical procedures were not performed in those patients. The time lapse from the primary to the secondary injury varied from 1 month to 20 years, with an average of 28 months. The secondary damage was caused by a secondary injury that was mild (22 cases) or developed insidiously (12 cases). Five types of secondary damage were observed: partial ACL tears that became complete--11 cases; meniscal tear--8 cases; loosening and subluxation of the anterior horn of the medial meniscus--14 cases; and fracture or damage to the articular condylar cartilage, with or without bone involvement--11 cases. It should be emphasized that the secondary damages were at times combined.