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INTRODUCTION
Anterior cruciate ligament (ACL) is composed
of two bundles, the anteromedial (AM) bundle
and the posterolateral bundle (PL). These two
bundles are tight in extension, the AM band
tightens between 45 and 90° of knee flexion
and seems to be mainly involved in anterior
tibia translation control, whereas PL band is
tighten at 30° of flexion and controls the
rotational stability [1, 2, 3]. Isolated injuries of
the ACL account for nearly half of all knee
ligament injuries [4] and primarily affect young
and active patients. Partial tears of ACL,
namely just one bundle injured, are observed in
10 to 28% of isolated ACL lesions [5, 6].
Functional consequences are moderate and
clinical relevance is usually poor. Patients
present a firm and delayed stop at the Lachman
test, a moderate anterior laxity and a weak or
no pivot shift [5]. MRI is not sensible to
distinguish partial from total ACL lesions. For
Van Dyck
& al.
, the sensibility is between 25%
and 53% [1]. The diagnosis of partial tears is
based on a combination of clinical and
paraclinical factors [1, 5, 6, 7]. Functional
treatment may be proposed in the absence of
meniscal or cartilaginous lesion.
The aim of this study was to analyse the level
of the return to sport after partial ACL rupture,
the rate of progression to a complete rupture
and of development of cartilaginous and menis
cal lesions in young and athletics patients.
MATERIALAND METHODS
A consecutive series of 41 patients presenting a
partial ACL tear between 2008 and 2014 is
reported.
Inclusion criteria were patients under the age of
30 years old presenting a partial ACL tear.
Exclusion criteria were associated meniscal or
chondral lesions, previous surgical history on
the index knee and contralateral ACL rupture.
The diagnosis of partial ACL tear was based on
a delayed firm stop at the Lachman test and a
differential laxitymeasured with the Rolimeter
®
less or equal to 5 mm and/or a weak or no pivot
shift. An MRI was done to assess the type of
ACL tear and the cartilage and meniscal status.
Non-surgical treatment was proposed and
based on a rehabilitation protocol including
quadriceps and hamstring strengthening,
neuromuscular rehabilitation. The absence of
pain and instability was regularly assessed.
The time between the ACL tear and the first
consultation, the type and the level of sport at
the time of the rupture were recorded.
CONSERVATIVE TREATMENT
AFTER PARTIAL ACL TEAR: IS
RETURN TO SPORT POSSIBLE?
J.M. FAYARD, G. DUBOIS DE MONT-MARIN,
B. SONNERY-COTTET, M. THAUNAT