Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Orthopaedic Surgery

Background: A partial rupture is likely secondary to the fact that the two bundles of the ACL have a synergistic yet distinctly different biomechanical function at different knee flexion angles. Recent interest focused on establishing pre and intraoperative ways of assessing the different types of symptomatic one bundle tears in order to perform an individual ACL augmentation. Treatment of partial ACL tears depends entirely on making an accurate diagnosis and determining degree of impairment. For some patients with partial tears, little morbidity is associated with the injury, and knee stability may be adequate for participation in sports and for all activities of daily living. Treatment in this scenario is largely supportive recommending that the patient take the time to recover from the initial injury and, after rehabilitation, to make a gradual return to sport. Operative intervention is needed in other cases, but such a decision should be taken while considering various factors, this includes: age, activity level, degree of laxity on physical examination, associated injuries, and symptomatic instability. Most clinicians would agree that symptomatic and debilitating instability require a more aggressive approach, likely in the form of operative intervention. The ACL augmentation is performed similar to a (traditional) single bundle technique while sparing the intact ACL fibers. This may support mechanical strength of the reconstruction, especially in the early postoperative period, and may maintain mechanoreceptors, neural elements and blood vessels to allow better proprioception, vascularization and an accelerated rehabilitation with faster return to sports

Issued also as CD