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. 2019 Jul 16;7(7):2325967119856624.
doi: 10.1177/2325967119856624. eCollection 2019 Jul.

Incidence and Risk Factors for a Partial Anterior Cruciate Ligament Tear Progressing to a Complete Tear After Nonoperative Treatment in Patients Younger Than 30 Years

Jean-Marie Fayard  1 , Bertrand Sonnery-Cottet  1 , Goran Vrgoc  1   2 , Padhraig O'Loughlin  1   3 , Geoffroy Dubois de Mont Marin  1   4 , Benjamin Freychet  1 , Thais D Vieira  1 , Mathieu Thaunat  1
Affiliations

Incidence and Risk Factors for a Partial Anterior Cruciate Ligament Tear Progressing to a Complete Tear After Nonoperative Treatment in Patients Younger Than 30 Years

Jean-Marie Fayard et al. Orthop J Sports Med. .

Abstract

Background: Partial anterior cruciate ligament (ACL) tears are observed in 10% to 27% of isolated ACL tears. There is currently no consensus on diagnosis and treatment protocols, and the outcomes of nonoperative treatment remain undefined.

Purpose: To assess the incidence and risk factors for the progression of partial ACL tears to complete ruptures after nonoperative treatment in active patients younger than 30 years.

Study design: Case-control study; Level of evidence, 3.

Methods: A total of 41 patients, all younger than 30 years and active in sports, were diagnosed with a partial ACL tear, with no associated meniscal or chondral lesions on magnetic resonance imaging (MRI). All were assigned to a nonoperative treatment program. The Lachman test, ≤4-mm side-to-side difference in laxity by Rolimeter, and MRI were utilized for the diagnosis. Tegner and International Knee Documentation Committee (IKDC) scores were assessed before and after the first lesion, and the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) score was assessed at last follow-up. Postinjury Tegner and IKDC scores were assessed before the second injury for patients progressing to a complete ACL tear and at last follow-up for patients without progression.

Results: At a mean of 43 months (range, 24-96 months), the partial ACL injury progressed to a complete ACL tear in 16 (39%) patients. In the remaining 25 patients without progression, the mean Tegner and IKDC scores were 7.0 and 96.0 before the injury and 5.9 and 85.7, respectively, at last follow-up. The mean ACL-RSI score was 69.3. The Tegner and IKDC scores were significantly lower at final follow-up (P = .0002 and P < .0001, respectively). Only 18 (44%) patients returned to their preinjury level of sports activities. A significantly increased risk of progression to a complete ACL tear was seen in patients ≤20 years (odds ratio, 5.19; P = .037) or patients practicing pivoting contact sports (odds ratio, 6.29; P = .026). Meniscal lesions were found in 50% of patients with a partial tear that progressed to a complete ACL tear.

Conclusion: A partial ACL injury progressed to a complete ACL tear in 39% of young active patients treated conservatively, with half of the complete tears presenting with a concomitant meniscal lesion at the time of reconstruction. Age ≤20 years and participation in pivoting contact sports were identified as significant risk factors for progression to a complete tear.

Keywords: anterior cruciate ligament; conservative treatment; meniscal injury; partial tear; pivoting sport.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.-M.F. is a paid consultant for Arthrex and Newclip Technics. B.S.-C. is a paid consultant for and receives royalties and research support from Arthrex. G.D.d.M.M. has received fellowship support from Arthrex. M.T. is a paid consultant for Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Timeline of evaluation. ACL-RSI, Anterior Cruciate Ligament Return to Sport After Injury scale; IKDC, International Knee Documentation Committee.
Figure 2.
Figure 2.
Flow chart. ACL, anterior cruciate ligament.
See this image and copyright information in PMC

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