ABSTRACT
This study documents outcomes of athletically active, skeletally immature patients
with proximal anterior cruciate ligament (ACL) tears treated with a non-reconstructive
technique to promote healing (“healing response”).
Between 1992 and 1998, 13 skeletally immature athletes with proximal ACL tears underwent
a healing response procedure. Patients with previous ACL injury, other concurrent
ligament pathology, and/or complete mid-substance ACL tears were excluded. Average
preoperative KT-1000 arthrometer manual maximum difference for all patients was 5
mm (range: 3-10 mm). Preoperatively, all patients had a 1+ or 2+ pivot shift, and
all patients reported knee function as abnormal or severely abnormal. Patients were
followed prospectively with clinical examinations, KT-1000 testing, and subjective
questionnaires.
Three (23%) patients had a re-injury 30 to 55 months after the healing response and
underwent subsequent ACL reconstruction. Subjective follow-up on the remaining 10
patients at an average of 69 months (range: 26-113 months) postoperatively indicated
no patients experienced pain or giving way, and all considered their knee function
normal. Average Lysholm score was 96, Tegner score was 8.5 (range: 7-10), and patient
satisfaction at follow-up was 9.9 (1=very dissatisfied and 10=very satisfied). Clinical
examination at least one year postoperatively was performed on 7 of 10 patients at
35 months (range: 12-63 months). Five patients had a negative pivot shift and 2 had
a 1 + pivot shift. KT-1000 measurements improved to 2 mm (range: 0-3 mm).
In the athletically active, skeletally immature patient, the healing response procedure
can restore stability and knee function, with proper patient selection. In this study
group, patients were very satisfied with the procedure and returned to a high level
of sports and activities.
