Fractures associated with an ACL injury need o be taken seriously

The main points are:

-          One study found that 71% of ACL injuries also had a fracture

-          Plain radiography often fails to detect these fractures

-          The fracture is best seen on MRI (T1) and is a markedly different pathology to bone bruises, traumatic bone marrow oedema or contusion

-          Different types of fractures include cortical depression fractures and trabecula fractures

-          Cortical depression fractures are likely to involve an meniscal tear in the same compartment

-          The sequale of fractures are articular cartilage abnormalities at folowup in more than 50% of patients after 6- 41 months

-           1 year follow ACL rupture those will associated fractures will have a significantly worse clinical outcome

Based on the increased incidence of articular cartilage changes and worse clinical course at 1 year, this article would appear to guide us towards slower rehabilitation of these patients, particularly with regards to returning to impact activities. It also suggests that our goals for these patients may be different. They should return to play at a slower rate, and in spite of good surgery and rehabilitation, may not always return to pre-injury activity. They are likely to have more problems later in life with osteoarthritis, so modifiable risk factors such as obesity should be managed.

 

(Guermazi, Roemer et al. 2018)Guermazi, A., et al. (2018). "Fractures associated with ACL injury need to be taken seriously." Br J Sports Med 52(1): 6-7.