Ra. Drongowski et al., PREDICTIVE VALUE OF MENISCAL AND CHONDRAL INJURIES IN CONSERVATIVELY TREATED ANTERIOR CRUCIATE LIGAMENT INJURIES, Arthroscopy, 10(1), 1994, pp. 97-102
Some degree of uncertainty remains in the natural history of anterior
cruciate ligament (ACL) tears treated conservatively with a supervised
rehabilitation program, counseling, and activity modifications. Sympt
omatic ACL-deficient individuals usually present for treatment, wherea
s the asymptomatic may not, thus making the true outcome difficult to
discern. The goal of this study was to identify which prognostic indic
ators available at the initial evaluation of an ACL-deficient knee cou
ld predict future disability. The hospital records of 107 individuals
who presented with an ACL-deficient knee (confirmed by arthroscopy) we
re reviewed. Follow-up (mean 51.7 months) was obtained on 99 individua
ls (93%) by telephone interview. The study sample was composed of 72 m
ales (67%), 83 acute injuries (78%), and 91 complete ACL tears (85%).
Furthermore, 81 individuals presented initially with associated knee i
njuries (87%), whereas 73 injuries were sports related (68%). Associat
ed injuries included 47 lateral meniscal tears (54%), 37 medial menisc
al tears (42.5%), 52 hyaline cartilage injuries (59.8%), and 16 other
ligament injuries (18.4%). Those individuals with associated injuries
to the meniscus did not show a reduction in the ability to run, second
ary to pain and/or swelling. However, those individuals with hyaline c
artilage defects did decrease their running due to pain and swelling.
In addition, more individuals with hyaline cartilage injury reported s
evere life-style changes compared with those individuals with isolated
lateral or medial meniscal injury. In this study, all individuals wit
h complete tears of the ACL treated nonoperatively experienced a signi
ficant decrease in their ability to participate in sporting activities
when compared with their preinjury participation level. In addition,
individuals with an ACL injury with associated hyaline cartilage injur
y were more likely than were those without hyaline cartilage injury to
do poorly on a nonoperative rehabilitation program stressing physical
therapy.