Four to ten year followup of unreconstructed anterior cruciate ligament tears

Abstract

Both operative and nonoperative methods have been advocated for the treatment of ACL tears. However, the optimum management of this injury remains contro versial. In the present study, patients treated nonoper atively were evaluated retrospectively 4 to 10 years after ACL tears were documented by arthroscopy and by mild to moderate pivot shifts under anesthesia. Forty-nine patients who underwent arthroscopic eval uation of the knee between 1976 and 1982 were found to have complete tears of the ACL. A mild to moderate pivot shift was present under anesthesia. One or both menisci were torn in two-thirds of the knees, requiring partial meniscectomies. The average age of the patients was 27 years (range, 16 to 46 years). Because of persistent disabling instability, 9 patients (18%) under went late ACL reconstruction. The remaining 40 pa tients were evaluated at an average of 5.6 years after documentation of the tear (range, 4 to 10 years). At followup, 25 (62%) of the 40 patients had satisfac tory subjective results. Eight of the patients (20%) had returned to their preinjury level of athletic activities without restrictions, and 10 (25%) functioned at the same level but with symptoms, some patients requiring bracing. Seventeen patients (43%) had diminished their level of sports activities, while 5 patients (12%) had given up all sports. Only 2 patients required late men iscectomies. On physical examination, 27 patients (87%) had pivot shifts. Instrumented laxity testing revealed an injured to normal difference of 3.1 mm with a 20 pound force. Radiographic studies were interpreted as normal in 35% of the knees, whereas 65% demonstrated mild degenerative changes. Overall, objective results were satisfactory in only 7 (23%) of the 31 patients, although 19 (61 %) were satisfied with their functional results. Numerous procedures are available for stabilizing the ACL insufficient knee. With improvement in our ability to diagnose an acute ACL tear, management must be based not only on the initial clinical findings, but on the patient's level of activity and functional expectations. Although only slightly more than 60% of the patients had satisfactory subjective results, many had adapted quite well to their ultimate functional disability through modification of activities. Few patients, however, re turned unrestricted to their preinjury level of function.