ACL Partial Tears

Dr Naveen Kumar LVMBBS, MS Orth, FRCS Orth (Eng), MCh Hip & Knee (UK)MSc Orth (UK), Dip SICOT (Italy), FEBOT (Portugal),MRCGP (UK), Dip FIFA SM (Switzerland), (FSEM (UK))

ACL Injury

Although a lot has been said about the treatment modalities for complete or near complete ACL tears, the partial tears of ACL are often under or over-treated as there are no clear guidelines regarding these. The partial ACL tears (Grade 1 and 2) are often under-reported and under-recognised.

The partial tears of the ACL ligament are usually due to more trivial twisting injury in comparison with the complete ACL ligament tear. Grade 1 stretch of ACL ligament can also be due to repetitive strain injury and not necessarily due to a particular injury.

Patients often present with instability symptoms akin to the patients with complete ACL tears, however often there may not be any history of injury. Another common presentation is in the form of patellar tendinopathy symptoms. These patients will have tendon irritation secondary to instability.

Examination

Thorough clinical examination is important to not miss subtle ACL laxity. The end point is typically felt in these patients on examination. Identifying this condition would be typically possible in the Lachman test, but may not be obvious on the Anterior Drawer’s test.

Investigation

MRI scan images may show sail sign of the ACL ligament or even a partial tear of the fibers. It is unusual to find any other significant findings.

Treatment of the partial tears of the ACL is less clear. High grade 2 partial tears of ACL need ACL reconstruction. However low grade partial tears with end point on clinical examination can be treated effectively with PRP (Platelet Rich Plasma) Injection to ACL. This is an OPD procedure either under ultrasound guidance or without that. But, this can help in healing of the ACL ligament in a natural way. Other alternatives being explored are stem cell therapy. Scaffolding + PRP injection or Scaffolding + Stem cell therapy.

Conclusion

Although the current concept of treatment of these injuries is in its nascent stage, a simple PRP injection seems to be the choice of treatment in the absence of any other viable alternatives. In case of failure of PRP to solve the problem, then arthroscopic ACL ligament augmentation surgery is the viable alternative to consider.