Rai S K, Gupta T P, Singh V B, Kale Amit, Vij Vineet, Shaki Omna
Department of Orthopaedics, Base Hospital, Guwahati, Assam, 781029, India.
Department of Orthopedics, INHS Kalyani, Visakhapatnam, AP, 530005, India.
Arch Orthop Trauma Surg. 2023 Apr;143(4):2063-2071. doi: 10.1007/s00402-022-04519-w. Epub 2022 Jul 2.
The anterior cruciate ligament (ACL) is a common knee ligament injury. Partial ACL tears are common, and at least 10-27% of isolated ACL tears are diagnosed as partial tears. Patients with partial tears have high risk of progression of tears to complete tears, which may require surgical reconstruction. The risk factors associated with the progression to a complete tear are poorly understood.
The present case-control study assessed the incidence and risk factors for the progression of conservatively treated partial ACL tears to complete tears in 351 patients younger than 45 years. The diagnosis of partial ACL tears was based on clinical evaluation, side-to-side difference on Rolimeter, and magnetic resonance imaging. These patients were managed conservatively and followed up for a mean of 17.5 months or until the progression of the tear into a complete tear, requiring surgery. The patients in whom the tear progressed to complete tear (group P) were compared with those in whom the tear remained stable for a minimum of 18-month follow-up period (group S).
Of the 351 partial ACL tear patients, 166 (47.3%) patients progressed to a complete tear at a mean duration of 17.5 months, whereas the tear in 185 (52.7%) patients remained stable and did not progress to a complete tear. Group P had mean international knee documentation committee (IKDC) scores and Tegner scores of 95.7 ± 3.7 and 7.6 ± 1.6, respectively, before the injury, and scores decreased to 52.4 ± 4.1 and 5.7 ± 2.2, respectively, at the 24-month follow-up.
Partial ACL tear progressed to a complete tear in 47.3% of evaluated patients. The associated risk factors were age less than 35 years, rigorous physical activities, high ACL-Return to Sport after Injury score during early rehabilitation days, early return to activity, and pivoting contact sports.
前交叉韧带（ACL）损伤是常见的膝关节韧带损伤。ACL部分撕裂很常见，至少10%-27%的单纯ACL撕裂被诊断为部分撕裂。部分撕裂的患者有很高的撕裂进展为完全撕裂的风险，这可能需要手术重建。但对于进展为完全撕裂的相关危险因素知之甚少。
本病例对照研究评估了351例45岁以下保守治疗的ACL部分撕裂患者进展为完全撕裂的发生率及危险因素。ACL部分撕裂的诊断基于临床评估、Rolimeter测量的双侧差异以及磁共振成像。这些患者接受保守治疗，平均随访17.5个月，或直至撕裂进展为完全撕裂而需要手术。将撕裂进展为完全撕裂的患者（P组）与在至少18个月随访期内撕裂保持稳定的患者（S组）进行比较。
在351例ACL部分撕裂患者中，166例（47.3%）在平均17.5个月时进展为完全撕裂，而185例（52.7%）患者的撕裂保持稳定，未进展为完全撕裂。P组受伤前国际膝关节文献委员会（IKDC）平均评分和Tegner评分分别为95.7±3.7和7.6±1.6，在24个月随访时分别降至52.4±4.1和5.7±2.2。
在47.3%的评估患者中，ACL部分撕裂进展为完全撕裂。相关危险因素包括年龄小于35岁、剧烈体育活动、早期康复期间较高的ACL损伤后恢复运动评分、过早恢复活动以及旋转接触性运动。
