Fetto and Marshall set out to define the course that follows an unresolved anterior cruciate ligament injury and the signs that identify it.
Hospital for Special Surgery series of 223 knees with ACL insufficiency, drawn from 327 patients with knee ligament injuries, treated early, late or without surgery.
Key Findings
Untreated knees deteriorated steadily: by 3 years none rated good‑to‑excellent on total score, and by 5 years only 15% rated better than poor.
Instability and giving way increased significantly with time in both isolated and combined ACL injuries. Functional disability did not progress significantly, but there was no evidence that it improved with time.
Isolated ACL tears looked milder at first but were no different from combined injuries in overall dysfunction by 2 years after injury.
The anterior drawer sign was positive in 209 of 223 knees (93.7%) at first evaluation and in every untreated knee seen more than 18 months after injury.
Only 34 of 99 patients with surgically documented ACL tears recalled an audible pop. Giving way was reported by 77% of the 176 not operated on early.
The authors rated early primary repair good‑to‑excellent on average, late intra‑articular reconstruction fair and pes anserine transfer poor long term. Lesion mix differed: only 14% of early repairs were isolated ACL tears.
Board pearl
Giving way is unexpected collapse of the knee, not precipitated by pain, locking or weakness. It occurs with simple activities such as changing direction or walking on uneven ground.
Authors' conclusion
Unresolved anterior cruciate ligament insufficiency follows a predictable natural history typified by a course of progressive knee dysfunction and deterioration. The progress of deterioration can be significantly modified or arrested by repair or reconstruction of the injured ligament.
Fetto and Marshall set out to define the course that follows an unresolved anterior cruciate ligament injury and the signs that identify it.
Hospital for Special Surgery series of 223 knees with ACL insufficiency, drawn from 327 patients with knee ligament injuries, treated early, late or without surgery.
Key Findings
Untreated knees deteriorated steadily: by 3 years none rated good‑to‑excellent on total score, and by 5 years only 15% rated better than poor.
Instability and giving way increased significantly with time in both isolated and combined ACL injuries. Functional disability did not progress significantly, but there was no evidence that it improved with time.
Isolated ACL tears looked milder at first but were no different from combined injuries in overall dysfunction by 2 years after injury.
The anterior drawer sign was positive in 209 of 223 knees (93.7%) at first evaluation and in every untreated knee seen more than 18 months after injury.
Only 34 of 99 patients with surgically documented ACL tears recalled an audible pop. Giving way was reported by 77% of the 176 not operated on early.
The authors rated early primary repair good‑to‑excellent on average, late intra‑articular reconstruction fair and pes anserine transfer poor long term. Lesion mix differed: only 14% of early repairs were isolated ACL tears.
Board pearl
Giving way is unexpected collapse of the knee, not precipitated by pain, locking or weakness. It occurs with simple activities such as changing direction or walking on uneven ground.
Authors' conclusion
Unresolved anterior cruciate ligament insufficiency follows a predictable natural history typified by a course of progressive knee dysfunction and deterioration. The progress of deterioration can be significantly modified or arrested by repair or reconstruction of the injured ligament.