International Orthopaedics

, Volume 17, Issue 4, pp 208–213 | Cite as

Knee function after anterior cruciate ligament ruptures treated conservatively

  • B. Engström
  • J. Gornitzka
  • C. Johansson
  • T. Wredmark
Article

Summary

Thirty-nine patients with ruptures of the anterior cruciate ligament (ACL) were treated conservatively and were subsequently examined at an average of 5.7 years after injury, the uninjured leg acting as a control. The Tegner activity score was significantly lower than the desired activity level. No patients were free of symptoms and only two could take part in sport which involved pivoting. The isokinetic knee extensor and flexor torques, as well as the one-leg-hop and instrumented knee joint laxity tests, were significantly impaired at follow-up. Functional impairment was not related to tests of knee joint laxity. Few patients were pleased with their subjective knee function after an ACL rupture despite thorough initial rehabilitation.

Résumé

On a examiné, 5,7 ans en moyenne (de 3 à 13) après le traumatisme, 39 patients de 34 ans d'âge moyen, traités orthopédiquement pour rupture unilatéral du ligament croisé antérieur (LCA). Le membre inférieur opposé a servi de contrôle. Le score d'activité de Tegner était significativement inférieur au niveau d'activité souhaité. Aucun patient n'était asymptomatique et seulement deux sur 39 pouvaient pratiquer des sports nécessitant des mouvements de pivotement. L'instabilité et la douleur étaient les symptômes les plus habituels. Le moment isokinétique de flexion et d'extension, le saut à cloche-pied, ainsi que la laxité du genou testée instrumentalement, étaient significativement altérés du côté blessé, lors de l'examen. La dégradation fonctionnelle n'était pas correlée avec les tests cliniques de laxité du genou. Peu de patients sont subjectivement satisfaits de la fonction de leur genou après rupture du LCA, malgré un programme particulier de réhabilitation.

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References

  1. 1.
    Andersson C, Gillquist J (1990) Instrumented testing for evaluation of sagittal knee laxity. Clin Orthop 256: 178–184Google Scholar
  2. 2.
    Andersson C, Odensten M, Good L, Gillquist J (1989) Surgical or non-surgical treatment of acute rupture of the anterior cruciate ligament. A randomized study with long-term follow-up. J Bone Joint Surg [Am] 71: 965–974Google Scholar
  3. 3.
    Arvidsson I, Eriksson E, Häggmark T, Johnson RJ (1981) Isokinetic thigh muscle strength after ligament reconstruction in the knee joint: results from a 5–10 year follow-up after reconstructions of the anterior cruciate ligament in the knee joint. Int J Sports Med 2: 7–11Google Scholar
  4. 4.
    Buckley SL, Barrack RL, Alexander AH (1989) The natural history of conservatively treated partial anterior cruciate ligament tears. Am J Sports Med 17: 221–225Google Scholar
  5. 5.
    Chick RR, Jackson DW (1978) Tears of the anterior cruciate ligament in young athletes. J Bone Joint Surg [Am] 60: 970–973Google Scholar
  6. 6.
    Clancy WJ, Ray JM, Zoltan DJ (1988) Acute tears of the anterior cruciate ligament. Surgical versus conservative treatment. J Bone Joint Surg [Am] 70: 1483–1488Google Scholar
  7. 7.
    DeHaven KE (1980) Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med 8: 9–14Google Scholar
  8. 8.
    Engström B, Forssblad M, Johansson C, Törnkvist H (1990) Does a major knee injury definitely sideline an elite soccer player? Am J Sports Med 18: 101–105Google Scholar
  9. 9.
    Eriksson E (1976) Reconstruction of the anterior cruciate ligament. Orthop Clin North Am 7: 167–179Google Scholar
  10. 10.
    Feagin JA, Blake WP (1983) Postoperative evaluation and result recording in the anterior cruciate ligament reconstructed knee. Clin Orthop 172: 143–147Google Scholar
  11. 11.
    Galway RD, Beaupré A, MacIntosh DL (1972) Pivot shift: A clinical sign of symptomatic anterior cruciate insufficiency. J Bone Joint Surg [Br] 54: 763–764Google Scholar
  12. 12.
    Giove TP, Miller SJ 3rd, Kent BE, Sanford TL, Garrick JG (1983) Non-operative treatment of the torn anterior cruciate ligament. J Bone Joint Surg [Am] 65: 184–192Google Scholar
  13. 13.
    Johnson J, Siegel D (1978) Reliability of an isokinetic movement of the knee extensors. Res Q 49: 88–90Google Scholar
  14. 14.
    Johnson RJ (1982) The anterior cruciate: a dilemma in sports medicine. Int J Sports Med 3: 71–79Google Scholar
  15. 15.
    Johnson RJ, Eriksson E, Häggmark T, Pope MH (1984) Five- to ten-year follow-up evaluation after reconstruction of the anterior cruciate ligament. Clin Orthop 183: 122–140Google Scholar
  16. 16.
    Jones KG (1970) Reconstruction of the anterior cruciate ligament using the central one-third of the patellar ligament. J Bone Joint Surg [Am] 52: 838–839Google Scholar
  17. 17.
    Kennedy JC, Weinberg HW, Wilson AS (1974) The anatomy and function of the anterior cruciate ligament. As determined by clinical and morphological studies. J Bone Joint Surg [Am] 56: 223–235Google Scholar
  18. 18.
    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10: 150–154PubMedGoogle Scholar
  19. 19.
    Mawdsley RH, Knapik JJ (1982) Comparison of isokinetic measurements with test repetitions. Phys Ther 62: 169–172Google Scholar
  20. 20.
    McDaniel WJ, Dameron TB (1980) Untreated ruptures of the anterior cruciate ligament. A follow-up study. J Bone Joint Surg [Am] 62: 696–705Google Scholar
  21. 21.
    Noyes FR, Mooar PA, Matthews DS, Butler DL (1983) The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg [Am] 65: 154–162PubMedGoogle Scholar
  22. 22.
    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198: 43–49PubMedGoogle Scholar
  23. 23.
    Tegner Y, Lysholm J, Gillquist J, Öberg B (1984) Two-year follow-up of conservative treatment of knee ligament injuries. Acta Orthop Scand 55: 176–180PubMedGoogle Scholar
  24. 24.
    Tegner Y, Lysholm J, Lysholm M, Gillquist J (1986) A performance test to monitor rehabilitation and evaluate anterior cruciate ligament injuries. Am J Sports Med 14: 156–159PubMedGoogle Scholar
  25. 25.
    Tegner Y, Lysholm J, Lysholm M, Gillquist J (1986) Strengthening exercises for old cruciate ligament tears. Acta Orthop Scand 57: 130–134Google Scholar
  26. 26.
    Torg JS, Conrad W, Kalén B (1976) Clinical diagnosis of anterior cruciate ligament instabilities in athlete. Am J Sports Med 4: 84–93Google Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • B. Engström
    • 1
  • J. Gornitzka
    • 2
  • C. Johansson
    • 1
  • T. Wredmark
    • 1
  1. 1.Section of Sports Medicine and Sports Trauma, Department of Orthopaedic SurgeryHuddinge University HospitalHuddingeSweden
  2. 2.Department of PhysiotherapyHuddinge University HospitalSweden

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