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J.M. FAYARD, G. DUBOIS DE MONT-MARIN, B. SONNERY-COTTET, M. THAUNAT
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In our study, the most exposed activities were
pivoting sport especially ski and soccer. We
reported a significant decrease of the Tegner
score after the partial ACL lesion. Functional
management allowed a return to sport at the
level before injury only in half of the patients
and 45% of them had progressed to a complete
rupture.
Noyes
& al.
evaluated 32 patients presenting a
partial ACL tear at a mean 7.3 years follow-up.
The rate of return to sport at the same level was
only 12.5%. No patient progressed to a
complete rupture [10]. Barrack
& al.
found
40% of 35 patients with partial ACL tears who
were able to return to their pre-injury level at a
mean 41 months follow-up. Age at the time of
the injury ranged from 15 to 45 years and the
level of sport was not advised [11]. Bak
& al.
evaluated 56 patients presenting a partial ACL
tear without associated meniscal or chondral
lesions at a mean 5.3 years follow-up. Sixty-
two percent had good or excellent knee function
with a Lysholm score between 84 and 100.
Only 30% patients resumed their preinjury
activities. If we consider patients under 30 years
old, only 5 patients on 16 (31%) were able to
return to their preinjury level. The authors
concluded that the prognosis for knee function
is good if pivoting sports are stopped [12]. We
noted a significant decrease of the IKDC
subjective score at the last follow-up after the
partial rupture. However, our patients had an
acceptable knee function at 3.4 years follow up
with a mean IKCD subjective score over 80%.
ACL-RSI score is described to analyse the
psychological impact of a ACL tear on return to
sport. In our study, we observed a mean ACL-
RSI score of 69/100 after partial ACL tears.
Even though IKDC subjective score was good,
we noted a decrease of the Tegner score. This
could be explained by an apprehension to
return to sport. We did not find a significant
relationship between the ACL-RSI score and
progression to a complete rupture.
We observed an important rate of progression
to a complete rupture (36.6%) at the last
follow-up. Noyes
& al.
found a progression to
a complete tear in 38% with 7.3 years of follow
up. The authors described 3 levels of partial
ACL lesions according to the amount of tear:
25, 50 and 75%. According to the authors, the
progression to a complete ACL tear was related
to the initial extent of the partial tear. This
evaluation was done by arthroscopy [10].
Actually, there is no place for arthroscopy in
the diagnosis of ACL lesions. Clinical
examination and MRI do not allow an
evaluation of the amount of the ACL damage.
Treatment is based on knee stability during
clinical examination and diagnosis of partial
tear on the IRM.
Fritschy
& al.
found 42% of complete rupture
at 6.5 years follow-up in a non-homogeneous
population. The mean age at the ACL partial
tear was 31 years (range 16 to 57 years) and
most of the patients had associated lesions. The
ruptures were arthroscopically graded in two
groups according to the amount of the ACL
tear : 25-50% and 50-75% of ligament rupture.
The authors concluded that it was impossible to
estimate the quality of the remnant ACL fibres
[13].
In their study, Bak
& al.
reported only 11% of
progression to a total tear on 56 patients. This
lower rate can be explained by an older
population (age between 17 and 48 years) and
a reduction of pivoting activities [12].
We observed an important rate of progression
to a complete rupture (36.6%) with a shorter
follow-up than what was published in the lite
rature. In our study, progression from a partial
to a complete ACL tears occurred at a mean
23.4 months follow-up. It might be explained
by the population we studied. Younger patients,
playing pivoting sport may present a greater
risk to progress to a complete tear.
Most of the authors who studied the outcomes
of partial ACL tears reported associated initial
meniscal and cartilage lesions. Noyes
& al.
found meniscal tears in 17 of 32 knees (53%)
presenting partial ACL tears [10]. In their
study, Fritschy
& al.
reported 25 of 43 patients
(58%) with initial associated lesions. Five
cartilage lesions were recorded [13]. These
authors did not evaluated associated lesions at
the last follow-up and the progression of these
lesions after complete tears.