2015 ISAKOS Biennial Congress ePoster #1361

Specific Early Management of Traumatic Lesions of the Anterior Cruciate Ligament and its Effects on the Displacement of the Ruptured Ligament Fibers – Prospective Study

Cyrille Delin, MD, Paris FRANCE
Xavier Poittevin, MD, Paris FRANCE
Benoît David, MD, Bourg Saint Maurice FRANCE
Robert Gotteland, MD, Val d'Isère FRANCE
Gilles Mugnier, MD, Les Gets FRANCE
Philippe Carrere, MD, Bourg Saint Maurice FRANCE
Stéphane Silvera, MD, Paris FRANCE
Paul Legmann, MD, PhD, Paris FRANCE
Philippe Thelen, MD, Paris FRANCE

RIM Maussins-Nollet, Paris, FRANCE

FDA Status Cleared

Summary: This study confirms the results of the epidemiological study presented at this same ISAKOS congress : initial early management of subjects with a suspected lesion of the ACL using a splint to restrict the ROM in flexion of the knee to between 30° and 60° yields a rate of more than 80% of non-displaced total ruptures of the ACL ; this type of rupture has a high potential to heal spontaneously wit

Rate:

Abstract:

Objective

The aim of this prospective study is to confirm the effects of the early application of a restricted splint in flexion and in extension on the displacement of ruptured ACL fibers. Indeed, an epidemiogical study presented at this ISAKOS congress, has shown that this type of splint gives a higher percentage of non-displaced ligamentous fibers in case of full ACL rupture.

MATERIALS & METHOD:
Our study protocol was approved by our institutional ethics review board and all subjects provided written informed consent.
Prospective study from December 2008 to May 2012 including patients who presented with a traumatic knee injury, involving a clinically suspected lesion of the ACL, in a winter sports resort. The patients must have consulted a mountain physician less than 48 hours after the injury.

The mountain physicians who participated in the study filled in a simplified IKDC objective form and applied the following inclusion criteria : a traumatic injury that had occurred less than 48 hours previously with a clinically suspected lesion of the ACL, patient living in the same city or its suburbs as the study centre, who were willing to wear a brace restricting the ROM of their knee in flexion to between 30° - 60° until the initial MRI, early MRI examination, including standard fat-saturation and diffusion-weighted T1 and T2 sequences. Diffusion-weighted MRI sequences yield information on whether the ligament is fully ruptured or not and show the position of the ligament fibers within the post-traumatic oedema.

Results

We included 242 patients (162 females and 80 males), mean age 38.2 years (range = 9 to 68 years) and the mean time between the traumatic injury and the MRI was 8.4 days (range = 2 to 33 days). 205 patients (84.7%) presented with a full rupture of the ACL and 37 (15.3%) were partially ruptured. In 82.4% of these 205 patients the ligament fragments remained in their initial position, parallel to the top of the intercondylar notch. The time that elapsed before the splint was applied (less than 6 hours, between 6 and 12 hours, between 12 and 48 hours) and the gender of the patient did not change the percentage of displaced and non-displaced ruptured ACLs. Only the age of the patient had an influence on the percentage of , non-displaced ruptured ACLs with 86.2% in the patients over 35 years versus 74.6% in those under 35.

Conclusion

This study confirms the results of the epidemiological study presented at this same ISAKOS congress : initial early management of subjects with a suspected lesion of the ACL using a splint to restrict the ROM in flexion of the knee to between 30° and 60° yields a rate of more than 80% of non-displaced total ruptures of the ACL ; this type of rupture has a high potential to heal spontaneously with suitable conservative treatment (see lectures presented at ISAKOS 2009 and 2015).