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CONSERVATIVE TREATMENT AFTER PARTIAL ACL TEAR: IS RETURN TO SPORT POSSIBLE?
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Because of the small sample number, statistical
tests were not utilized to evaluate normality.
Instead, the assessment was performed with
non-parametric equivalents. The relationship
between the variables was studied with the chi²
test, Fisher’s exact test, or Mann Whitney test,
depending on what corresponded. The
inference in continuous variables was
calculated with the paired-samples
T
-test and
their results are presented with their 95%
confidence interval (95% CI). The level of
significance was set at 5% (α=0.05), bilateral
approximation.
DISCUSSION
Partial tears of the ACL are reported to
represent up to quarter of all ACL ruptures.
Diagnosis may frequently be difficult because
of poor functional consequences and clinical
relevance. MRI accuracy is also known to be
insufficient.
Our approachwas to appreciate if a conservative
management for partial ACL tear can
reasonably be proposed to the most exposed
population, where the functional requirement
is the most important. Considering this point,
the ability to return to sport, the rate of
progression to a complete ACL rupture and the
rate of associated lesions were evaluated.
Conservative treatment was initially proposed
as the gold standard in case of partial tears.
Odensten
& al.
followed 21 patients presenting
partial ACL tears conservatively treated at a
mean 6 years follow-up. All patients had good
or excellent results. The mean Lysholm score
was 93±6 points. Three were considered as
unstable at final follow-up [8]. Sommerlath
& al.
evaluated 19 patients with partial ACL
tears at 15 years follow-up. Knee function was
rated as good with a mean Lysholm score of
93 points. None of the patients complained of
instability [9]. The authors considered
conservative treatment as effective only if the
patients decrease their activity level. These
studies evaluated a heterogeneous population
of patients in term of age and meniscal status.
Even if associated lesions were found in more
than half of the knees presenting a partial ACL
tear, the authors considered that non-operative
management can be established. Our study
analysed a homogenous population presenting
a partial ACL tear. All of the patients were
active and aged less than 30 years. Initially,
none of them had cartilage or meniscal lesions.
The aim of most patients presenting an ACL
lesion is return to the same sport and ideally at
the same level. Noyes
& al.
did not find any
correlation between the Tegner score before
and after injury and the progression to a
complete ligament deficiency [10].
Table 1: Tegner score related to the progression or not to a total ACL tear