Avaliação da evolução de lesões associadas à lesão do ligamento cruzado anterior <span class="so-article-trans-title" dir="auto"> Translated title: Progress assessment of injuries associated to anterior cruciate ligament injuries </span>

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Abstract

PROPOSTA: Revisamos 71 pacientes com diagnóstico de lesão do ligamento cruzado anterior em 72 joelhos. Foi avaliado a incidência de lesões associadas (meniscais ou condrais) de acordo com o tempo até a cirurgia de reconstrução do ligamento. TIPO DE ESTUDO: Estudo retrospectivo de série de casos. MÉTODOS: Realizado análise estatística do efeito do tempo até a cirurgia com o aumento de lesões associadas. RESULTADOS: Não houve alteração, estatisticamente significante, da incidência de lesões condrais e meniscais avaliadas nos períodos 2 a 3 meses, 4 a 6 meses, 7 a 12 meses, 13 a 24 meses e mais que 24 meses. CONCLUSÕES: Embora haja uma tendência de aumento de lesões meniscais após 6 meses e de lesões condrais após 12 meses da lesão do ligamento cruzado anterior, tal fato não mostrou significância estatistica.

Translated abstract

PURPOSE: We reviewed 71 patients diagnosed with anterior cruciate ligament (ACL) injury on 72 knees. The incidence of associated injuries (meniscal and joint cartilage injuries) were evaluated according to the time elapsed until ACL reconstruction. STUDY DESIGN: Retrospective case series. METHODS: Statistical analysis of the relationship between the time elapsed until surgery and the increase of associated lesions. RESULTS: There was no statistically significant difference on the incidence of joint-cartilage and meniscal injuries assessed for the periods within 2-3 months, 4-6 months, 7-12 months, 13-24 months and above 24 months. CONCLUSION: Although a trend towards a higher number of meniscal injuries after 6 months, and of joint-cartilage injuries after 12 months since the primary anterior cruciate ligament injury, such fact showed no statistical significance.

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Most cited references 29

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Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis.

J Gillquist, K Messner (1999)

Knee ligament injuries are common in sport. A rupture of the anterior cruciate ligament (ACL) is the most serious of these injuries because it may cause long term disability. In this literature review, the frequency of post-traumatic gonarthrosis is examined. There are few long term prospective studies but a number of retrospective studies with follow-up times between 5 and 20 years have been published. These studies show that radiographic gonarthrosis is significantly increased after all knee injuries compared with the uninjured joint of the same patient. Isolated meniscus rupture and subsequent repair, or partial or total ruptures of the ACL without major concomitant injuries, seem to increase the risk 10-fold (15 to 20% incidence of gonarthrosis) compared with an age-matched, uninjured population (1 to 2%). Meniscectomy in a joint with intact ligaments further doubles the risk of gonarthrosis (30 to 40%), and 50 to 70% of patients with complete ACL rupture and associated injuries have radiographic changes after 15 to 20 years. Thus, an ACL rupture combined with meniscus rupture or other knee ligament injuries results in gonarthrosis in most patients. Ten to 20 years after ACL injury, gonarthrosis often presents as a slight joint space reduction or, occasionally, joint space obliteration (Ahlbäck grades I to II), but is usually not associated with major clinical symptoms. According to the few longitudinal studies, the progress of gonarthrosis is slow, and in some cases the condition seems to remain stable. Time is an important determinant for the degree of gonarthrosis and problems demanding treatment may be encountered only at > 30 years after the initial accident.

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Conservatively treated tears of the anterior cruciate ligament. Long-term results.

Tiina Järvinen, P Kannus (1987)

Forty-nine patients who had a complete tear and forty-one who had a partial tear of the anterior cruciate ligament were examined as regards long-term healing. All had had a positive clinical diagnosis just after the injury, which was confirmed in the majority under anesthesia, at arthrotomy, on arthroscopy, or with a combination of these methods. The re-examination was performed an average of eight years after the injury. Besides a functional and objective evaluation, radiographic examination and evaluations of isokinetic and isometric strength were made. The multidimensional analysis revealed that in an unselected population the long-term results of the complete tears were poor, because of chronic instability. In many, reconstructive operations were needed, and post-traumatic arthritis was common. In the patients who had a partial tear, the results were quite good even if the stability of the knees had not improved when compared with the initial post-traumatic status. Conservative treatment of complete tears of the anterior cruciate ligament cannot be recommended as a treatment of choice, whereas partial tears can be treated by non-operative methods.