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Sports Medicine

Partial ACL tear

11/17/2009

Question:

My daughter was just diagnoised with a partial tear in her ACL. She is a very active athelete in moderate pivitol sports( according to the list). The course of action taken is rehab for 8 weeks then re-evaluate with the k-1000 test. The Doctor was pretty encouraging about recovery and returning to her normal activity. When we went to our sports medicine appt she was less encouraging. Saying fair to good chance of recovery without further injury. I know it is hard to say what the out come will be at this time in her recovery process but is this the best course of action if she is a possible college prospect athelete?

Answer:

Specific treatment recommendations should be based upon the specifics of each patient's situation. In your daughter's case, details which would factor into her outcome, and to be discussed with her physician(s), include:

- the basis for and certainty of her diagnosis of a "partial ACL tear"... that is, is there definitely increased ACL laxity on exam, or is this diagnosis based on MRI findings?

- any concomitant injury - in particular, meniscal tears and/or damage to articular cartilage?

- whether your daughter has reached skeletal maturity (finished growing);

- although the KT-1000 device objectively measures the amount of static knee laxity, this may not correlate with knee instability (giving-way or buckling) symptoms... that is, there may be knee laxity but no instability, and vice versa... if abnormal ACL laxity has been demonstrated and is then redemonstrated in 8 weeks, this doesn't absolutely contraindicate a return to sports...;

- ACL bracing may be an option to consider;

- proper form/technique including leg-body alignment during sports activities, particularly during such "deceleration" activities as landing from a jump, to minimize ACL stress and risk for re-injury;

- adequate rehabilitation prior to resuming participation in high- demand activities, including optimal strength of hip and other "core" muscles - in addition to thigh muscle strengthening - along with balance and agility training and aerobic conditioning; and

- the pros and cons of possible surgical intervention in the future, although ACL reconstruction is usually not done for isolated partial ACL tears, but knee surgery could be considered later if a comprehensive course of non-operative treatment has failed to eliminate knee pain/swelling/instability episodes.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University