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[Does partial anterior cruciate ligament rupture really exist?].

M Schärlig1, P Segantini

  • 1Chirurgische Klinik, Schwerpunktspital Uster.

Helvetica Chirurgica Acta
|February 1, 1991
PubMed
Summary

Diagnosing partial anterior cruciate ligament (ACL) tears is challenging. Many diagnosed partial ACL tears are actually complete ruptures, often leading to knee instability and poor outcomes.

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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.

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