Predictive value of meniscal and chondral injuries in conservatively treated anterior cruciate ligament injuries

Some degree of uncertainty remains in the natural history of anterior cruciate ligament (ACL) tears treated conservatively with a supervised rehabilitation program, counseling, and activity modifications. Symptomatic ACL-deficient individuals usually present for treatment, whereas the asymptomatic may not, thus making the true outcome difficult to discern. The goal of this study was to identify which prognostic indicators available at the initial evaluation of an ACL-deficient knee could predict future disability. The hospital records of 107 individuals who presented with an ACL-deficient knee (confirmed by arthroscopy) were reviewed. Follow-up (mean 51.7 months) was obtained on 99 individuals (93%) by telephone interview. The study sample was composed of 72 males (67%), 83 acute injuries (78%), and 91 complete ACL tears (85%). Furthermore, 81 individuals presented initially with associated knee injuries (87%), whereas 73 injuries were sports related (68%). Associated injuries included 47 lateral meniscal tears (54%), 37 medial meniscal tears (42.5%), 52 hyaline cartilage injuries (59.8%), and 16 other ligament injuries (18.4%). Those individuals with associated injuries to the meniscus did not show a reduction in the ability to run, secondary to pain and/or swelling. However, those individuals with hyaline cartilage defects did decrease their running due to pain and swelling. In addition, more individuals with hyaline cartilage injury reported severe life-style changes compared with those individuals with isolated lateral or medial meniscal injury. In this study, all individuals with complete tears of the ACL treated nonoperatively experienced a significant decrease in their ability to participate in sporting activities when compared with their preinjury participation level. In addition, individuals with an ACL injury with associated hyaline cartilage injury were more likely than were those without hyaline cartilage injury to do poorly on a nonoperative rehabilitation program stressing physical therapy.