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Review
. 2015 Feb 14;50(1):9-15.
doi: 10.1016/j.rboe.2015.02.003. eCollection 2015 Jan-Feb.

Partial tearing of the anterior cruciate ligament: diagnosis and treatment

Eduardo Frois Temponi  1 , Lúcio Honório de Carvalho Júnior  1 , Bertrand Sonnery-Cottet  2 , Pierre Chambat  2
Affiliations
Review

Partial tearing of the anterior cruciate ligament: diagnosis and treatment

Eduardo Frois Temponi et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

Partial tears of the anterior cruciate ligament (ACL) are common and represent 10-27% of the total. The main reasons for attending to cases of non-torn bundles are biomechanical, vascular and proprioceptive. Continued presence of the bundle also serves as protection during the healing process. There is controversy regarding the definition of these injuries, which is based on anatomy, clinical examination, translation measurements, imaging examinations and arthroscopy. The way in which it is treated will depend on the existing laxity and instability. Conservative treatment is optional for cases without instability, with a focus on motor rehabilitation. Surgical treatment is a challenge, since it requires correct positioning of the bone tunnels and conservation of the remnants of the torn bundle. The pivot shift test under anesthesia, the magnetic resonance findings, the previous level and type of sports activity and the arthroscopic appearance and mechanical properties of the remnants will aid the orthopedist in the decision-making process between conservative treatment, surgical treatment with strengthening of the native ACL (selective reconstruction) and classical (anatomical) reconstruction.

Lesões parciais do ligamento cruzado anterior (LCA) são comuns e representam 10–27% das totais. As principais razões para atenção ao feixe não rompido são biomecânicas, vasculares e proprioceptivas. A permanência do feixe serve ainda de proteção durante o processo cicatricial. A definição dessa lesão é controversa, baseada na anatomia, no exame clínico, na medida da translação, nos exames de imagem e na artroscopia. Seu tratamento vai depender da frouxidão e da instabilidade existentes. O tratamento conservador é opcional para casos sem instabilidade, com enfoque na reabilitação motora. O tratamento cirúrgico é desafiador, pois exige correto posicionamento dos túneis ósseos e conservação dos remanescentes do feixe rompido. O teste do pivot-shift sob anestesia, os achados à ressonância magnética, o nível e o tipo de atividade esportiva prévia e o aspecto artroscópico dos remanescentes e suas propriedades mecânicas auxiliarão o ortopedista no processo decisório entre o tratamento conservador, o tratamento cirúrgico com reforço do LCA nativo (reconstrução seletiva) ou a reconstrução clássica (anatômica).

Keywords: Anterior cruciate ligament/injuries; Anterior cruciate ligament/surgery; Knee.

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Figures

Fig. 1
Fig. 1
Magnetic resonance imaging of partial tears of the anterior cruciate ligament of the knee. (A) Injury to the posterolateral band and preservation of the anteromedial band; (B) injury to the anteromedial band and preservation of the posterolateral band.
Fig. 2
Fig. 2
Arthroscopic view of partial tears of the anterior cruciate ligament of the knee. (A) Injury to the anteromedial band and preservation of the posterolateral band; (B) injury to the posterolateral band and preservation of the anteromedial band.
See this image and copyright information in PMC

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