One of the treatment dilemmas that the sports physician is faced with is that of the partial tear of the anterior cruciate ligament.
The definition of the partial tear is:
- History of injury to the anterior cruciate ligament
- Positive Lachman test with a firm end point
- Negative pivot shift test
- Arthroscopic evidence of injury to the anterior cruciate ligament.
- KT-1000 side to side difference of < 5 mm.
The natural history of the partial tear is controversial. There have been reports that suggest that both conservative and operative treatment give good results. The paper by Noyes had a 50% incidence of instability in high demand sports participation athletes with an anterior cruciate ligament tear > 50%. They also had a 75% incidence of re-injury. This suggests that patients in high demand sports require reconstruction.
The paper by Freunsgaard had good results with conservative treatment in patients who avoided high demand athletics.
Buckley reported that the degree of anterior cruciate tear did not correlate with outcome. Only half of their patients were able to resume their previous level of sports.