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Saturday, March 18, 2000

ACL tears while skiing worse than once believed

Anterior cruciate ligament (ACL) tears sustained while skiing generate greater intra-articular damage than once believed, according to a retrospective study of the medical records of 91 patients who sustained complete ACL tears between January 1993 and December 1998.

The investigation encountered a 63 percent rate of concurrent meniscal tears, and osteochondral injuries in as many as one-third of all the injured skiers, said Mark Rekant, MD, resident New York University-Hospital for Joint Diseases, who presented the study in poster exhibit 284. Older skiers were noted to have a remarkably higher percentage of accompanying meniscal tears. Realization that the "isolated" ACL injury in skiers is less frequent than previously thought, a more diligent approach in which a more aggressive surgical, Dr. Rekant said.

None of the patients in the study were professional skiers nor had any history of a prior knee injury. The mean age of the patients was 31.6 (range, 16 - 54). The diagnosis of an ACL tear was made initially by history and physical exam and subsequently supported by MRI findings. Arthroscopic-assisted ACL reconstruction was performed when the patient was functionally optimized. At the time of surgery, the associated intra-articular abnormalities were documented (meniscal, osteochondral, or ligamentous) in addition to reconfirming associated extra-articular findings (MCL, LCL tears).

An associated meniscal tear was detected in 57 of the 91 patients (63 percent) evaluated. In total, there were 71 meniscal tears (31 lateral meniscal, 40 medial meniscal) in 57 skiers. Fourteen of the 71 (20 percent) tears were amenable to surgical repair. Of patients over 40 years of age, 94 percent (17 of 18) were documented to have coexisting meniscal tears of which four were repaired. Overall, of the 57 skiers with a meniscal tear, 26 (45 percent) had an isolated medial meniscal tear; 17 (30 percent) had an isolated lateral meniscal tear; and 14 (25 percent) had both lateral and medial meniscal tears. Additional intra-articular knee injuries noted at the time of surgery included osteochondral changes of at least grade II in nature in 31 (34 percent) of the patients. Extra-articularly, 14 (15 percent) sustained MCL tears; and one of the 91 patients sustained a concomitant PCL tear.

Others participating in the study were Orin Sherman, MD, chief, orthopaedic sports medicine, department of orthopaedics, New York University-Hospital for Joint Diseases, N.Y.; Steven Stecker, MD; and John Bonamo, MD.

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2000 Academy News March 18 Index B

Last modified 06/March/2000 by IS