LIVRE JDG 2016

J.M. FAYARD, G. DUBOIS DE MONT-MARIN, B. SONNERY-COTTET, M. THAUNAT

228

The functional evaluation of the knee before

the trauma was done using IKDC subjective

score and the level of sport was evaluated with

the Tegner score.

All patients were systematically examined at

one year follow-up after the injury. The anterior

and the rotatory stability were analysed using

the Lachman test, an instrumented evaluation

of the anterior drawing with the Rolimeter

and

the jerk test.

Furthermore, all patients were contacted to

know if they were stable and if they presented

a complete ACL tear. The Tegner and IKDC

subjective scores were also recorded. The

ACL-RSI score was done to analyse

psychological impact of the tear on the return

to sport.

RESULTS

Forty one patients, 24 men (59%) and

17 women (41%) were included. The mean age

at the time of the ACL tear was 21 years (range,

15 to 29).

The mean time between injury and the first

consultation was 61 days (range, 2 to 271). All

the patients presentedACL tear during pivoting

sports. Ski (29%) and soccer (20%) were the

more frequently reported activities.

Initially, all the patients presented a firm and

delayed stop at the Lachmann test. The mean

differential anterior laxity was 2.6 mm (range,

0 to 5). Pivot shift was absent in 34 patients

(83%), noted as glide in 2 (5%) and marked in

4 patients (10%). The pivot shift could be

evaluated in one patient. On the initial MRI,

the ACL lesion was considered as partial in

89% and complete in 11%. All the patients did

not present any meniscal or cartilage lesion.

The mean Tegner score before the ACL tear

was 7±1 (range, 5 to 10) and the mean IKDC

subjective score was 96.4±4 (range, 84 to 100).

At mean 8.4 months follow-up (range, 1 to 33),

100% of the patients still presented an early or

delayed firm stop at the Lachman test. The

mean differential anterior laxity was 1.9 mm

(range, 0 to 5). Pivot shift was absent in 89%,

noted as glide in 4% and marked in 7%.

The mean Tegner score was 6.2±2 (range,

3 to 9) and the mean IKDC subjective score

was 83±12 (range, 54 to 100). We found a

significant decrease for both score (

<0.05).

The mean ACL-RSI score was 68.8±18 (range,

38 to 100).

All the patients were contacted at a mean

3.4 years (range, 2 to 8) follow-up from the

partial rupture.

Twenty six patients still presented a partial tear

and did not progress to a total rupture. The mean

IKDC subjective score and Tegner score in this

population were respectively 83.6±10 (range,

68 to 100) and 5.8±1.6 (range 3 to 8). The ACL-

RSI score in this population was 69±18 (range,

43 to 98). Fifteen patients progressed to a

complete rupture (36.6%). The mean IKDC

subjective score and Tegner score in this

population before the complete ACL rupture

were respectively 80.5±17 (range: 54 to 100)

and 7.5±1.2 (range: 6 to 9).The ACL-RSI score

in this population was 67±21 (range: 38 to 100).

The mean time between partial and total tear

was 23.4 months (range: 5 to 43). The complete

ACL rupture occurred in a sport trauma in

12 cases (80%) and without any trauma in

3 cases (20%).

A progression of meniscal lesions was found in

8 patients (53%). We did not have this

information for one patient. No chondral

lesions were recorded.

Tegner score after partial ACL tear was

significantly higher in patients who progress to

a complete lesion (7.5±1.2) than the others

(5.8±1.6) (

=0.03). Only 50% of the patients

returned to sport at the same level and 45% of

them progressed to a total tear (Table 1).

There were no significant difference concerning

gender, anterior laxity, pivot shift test, IKDC

and ACL RSI score between the two groups at

the first examination and at 1 year follow-up.