Spontaneous healing of acute ACL ruptures: rate, prognostic factors and short-term outcome

Abstract

Introduction Anterior cruciate ligament (ACL) reconstruction is considered the first line treatment in ACL rupture. However, some patients return to high intensity sport activities and show a normal knee function without ACL reconstruction. Therefore, aim of this study was to evaluate the rate and prognostic factors of spontaneous healing in patients with ACL rupture and the short-term functional outcome. Methods The rate, prognostic factors and short-term functional results of spontaneous healing in patients with ACL rupture were evaluated in 381 patients. Morphology of ACL rupture and extent of posterior tibial slope (PTS) were classified by MR- and x-ray imaging. In patients with normal knee stability in anesthesia examination and healed ACL during the arthroscopy 6 weeks after trauma ACL reconstruction was canceled. IKDC -, Tegner Activity Score, KT 1000 testing and radiological characteristics were collected 12 months postoperatively in these patients. Results 14.17% of the patients with ACL rupture showed a spontaneous healing after 6 weeks. Femoral ACL-rupture (p < 0.02) with integrity of ligament stump > 50% (p < 0.001), without bundle separation (p < 0.001) and decreased PTS (p < 0.001) was found significantly more often in patients with a spontaneous healed ACL. The average IKDC score was high at 84,63 in patients with healed ACL at 1 year follow-up, but KT 1000 testing was inferior compared to non-injured side. Conclusion Spontaneous healing of a ruptured ACL happened in 14% of the patients. Especially in low-demand patients with femoral single bundle lesions without increased posterior tibial slope delayed ACL surgery should be considered to await the possibility for potential spontaneous ACL healing.

The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears

“…The differentiation between partial tears with an intact ACLs and complete tears is crucial for determining patient prognosis and treatment methods. Conservative treatment can be effective for partial tears in children, adolescents and adults without high activity levels, especially for those with an intact synovial sheath and without symptomatic knee instability [ 10 – 12 ]. In these patients, distinguishing between a partial tear and a complete tear may be crucial in avoiding unnecessary surgery.…”

Ligament Healing After Anterior Cruciate Ligament Rupture: An Important New Patient Pathway?

“…7 According to Blanke et al ACL healing happened in lowdemand patients with femoral single bundle lesions without increased posterior tibial slope. 8 In general, evidence is lacking regarding which criteria may indicate whether ACL healing is possible after an injury. 5 The healing process of the ACL is still poorly understood, and it is difficult to know which patients are likely to have a healed ACL.…”