[Does partial anterior cruciate ligament rupture really exist?]

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Biomechanics

Background:

• Arthroscopic diagnosis of anterior cruciate ligament (ACL) injuries between 1983 and 1989 revealed a significant number of partial tears.
• The clinical significance and accurate diagnosis of partial ACL tears were areas of concern, potentially impacting patient outcomes.
• Distinguishing between partial and complete ACL ruptures is critical for appropriate treatment and management strategies.

Purpose of the Study:

• To evaluate the diagnostic accuracy of arthroscopy for partial anterior cruciate ligament (ACL) tears.
• To assess the clinical outcomes and long-term effects of injuries initially diagnosed as partial ACL tears.
• To determine if partial ACL tears should be reclassified as complete ruptures based on clinical evidence and surgical findings.

Main Methods:

• A cohort of 129 patients diagnosed with partial anterior cruciate ligament (ACL) tears via arthroscopy from 1983 to 1989 was analyzed.
• A surgical technique involving splitting the synovial sheath of the ACL was employed to better assess fiber continuity and confirm tear extent.
• Clinical review of 42 patients with initial partial ACL tear diagnoses was conducted to evaluate knee stability and functional outcomes.

Main Results:

• Splitting the synovial sheath frequently revealed complete anterior cruciate ligament (ACL) ruptures, leading to a decrease in the diagnosed rate of partial tears from approximately 10% to 3% during the study period.
• Clinical follow-up of patients with partial ACL tear diagnoses showed unfavorable outcomes: 12% very good, 14% good, 41% fair, and 26% poor results.
• A significant proportion of patients initially diagnosed with partial ACL tears experienced knee instability and functional deficits.

Conclusions:

• Arthroscopic diagnosis of partial anterior cruciate ligament (ACL) tears may overestimate their prevalence and underestimate the severity of the injury.
• The unfavorable clinical outcomes observed in patients with partial ACL tears suggest they often represent complete ruptures.
• It is recommended that most injuries initially diagnosed as partial anterior cruciate ligament (ACL) tears be treated as complete ruptures due to the high risk of instability and poor functional results.