The Current Status of Partial Rupture of Anterior Cruciate Ligaments in Sport Players Coming for Examination and Treatment at Tan Son Nhat Hospital, An Sinh Hospital and Gia An Hospital in Ho Chi Minh City, Viet Nam

The study employed methods of clinical and paraclinical medical examination and statistical mathematics to investigate the current status of partial rupture of anterior cruciate ligament (ACL) in sports players examined at An Sinh Hospital, Tan Son Nhat Hospital and Gia An Hospital (n = 33). The results of both clinical and paraclinical tests clearly showed that partial rupture of the ACL had a significant impact on the patients’ knee joint function. However, signs such as pain level were not too large (only average) making the patients easy to get subjective. If not treated promptly, the ACL could be completely ruptured. Therefore, it is necessary to pay attention to the screening of ACL to avoid missing lesions. Furthermore, if treated early, the remaining ACL should be a good foundation for the support and orientation of collagen fiber proliferation. As a result, it is necessary to have early intervention measures to improve and restore knee function helping patients return to sports activities soon.

Introduction

Ligament injuries often occur in the ankle area or knee joint [1]. Although ankles are injured more often, knee injuries are the leading cause of sports-related surgery [2], [3]. Annual ACL injury in the US accounts for about 1/1000 people [4]. Knee injuries greatly affect sports activities and can even end an athlete’s athletic career [5], [6]. One of the most common injuries to the knee joint in sports is the complete rupture of the ACL causing joint instability as a result of which it is necessary to surgically reconstruct a completely new ligament to protect the knee from complications of joint damage at a high cost [7], [8].

Another injury that is easily missed is a partial rupture of the ACL, meaning that the ligament has partial continuity of the structure, in which case it is difficult to persuade the patient to agree to surgery because his/her knee function is still operating within acceptable limits. If this damage lasts for a long time, it can cause a complete rupture of the ACL and may cause osteoarthritis [9]. Another reason, if the surgery completely removes the damaged ligament to rebuild a new one, it is a disadvantage for the sports players to spend a long time to recover [10].

Materials and Methods

To conduct this research, the methods of document synthesis and analysis, clinical and paraclinical medical examination, and statistical mathematics were used. The survey subjects were sports players with partial rupture of the ACL coming to An Sinh Hospital, Tan Son Nhat Hospital and Gia An Hospital for examination. The period was from 2018 to 2023.

Results

Survey Results of General Characteristics and Characteristics of Partial ACL Rupture of Sports Players Examined at An Sinh Hospital, Tan Son Nhat Hospital and Gia An Hospital

General Features

The study statistically analyzed the following factors: gender, age and the sports in which the patient participated.

Gender characteristics: It is shown in Table I that female patients accounted for a higher proportion than men, specifically female patients with partial rupture of the ACL were 19/33 cases (accounting for 57.58%) while male patients were 14/33 cases (accounting for 42.42%).

Table I. Gender Characteristics of the Studied Patient Group (n = 33)

Gender	Number of patients	Ratio (%)
Female	19	57.58
Male	14	42.42
Total	33	100

Age characteristics: Table II reveals that the youngest patient with a partial rupture of the ACL was 18 years old while the oldest was 65. The average age was 34.82 with a standard deviation of ±12.28. Among them, the age group from 21 to 30 accounted for the highest rate of 12/33 cases (36.36%). Next, the age group from 31 to 40 included 11/33 cases (accounting for 33.33%). The total of the two groups from 21 to 40 accounted for a very high proportion of 23/33 cases (69.69%). The situation can be explained by the fact that these groups were active and participated more intensely in sports activities than other ages.

Table II. Age Characteristics of the Studied Patient Group (n = 33)

Age group	Number of patients	Ratio (%)
≤20	1	3.03
21–30	12	36.36
31–40	11	33.33
41–50	3	9.09
51–60	3	9.09
61–70	3	9.09
Total	33	100.00
Mean ± SD	34.82 ± 12.28
Min-Max	18–65

Sports in which the patients participated: Table III describes the 05 sports that the patient group participated in (Running, Soccer, Aerobics, Gym and Badminton). In particular, the sport in which patients participated and suffered from partial ACL rupture injury accounted for the highest rate was Running (accounting for 57.58%), followed by Football accounting for over 27.27%. The two sports with patients with partial rupture of the ACL accounted for the lowest rate in 33 cases including Gym with 2/33 (accounting for 6.06%) and Badminton with 1/33 (accounting for 3.03%).

Table III. Sports in Which Patients Participated (n = 33)

No	Sport	Number of patients	Ratio (%)
1	Running	19	57.58
2	Soccer	9	27.27
3	Aerobic	2	6.06
4	Gym	2	6.06
5	Badminton	1	3.03
Total		33	100.00

Lesion Features

The study investigated the following lesion characteristics: collision or non-collision injuries, damaged knees (right/left), accompanying lesions, and time from trauma to laparoscopic surgery.

Injury due to collision or non-collision: As shown in Table IV, the partial rupture of ACL not due to collision occurred in 28/33 cases (accounting for 84.85%) while the number related to collision was only 5/33 cases (accounting for 15.15%), which reveals a very high rate of potential injury. Non-competitive and repetitive sports activities could potentially cause injury.

Table IV. Injury Characteristics Collision or Non-Collision of the Studied Patient Group (n = 33)

Injury characteristics	Number of patients	Ratio (%)
Collision	5	15.15
Non-collision	28	84.85
Total	33	100.00

Damaged knees: There was a difference in position-the right knee accounted for nearly 70% of injuries while the left one accounted for approximately 30% (Table V).

Table V. Damaged Knee Characteristics of the Studied Patient Group (n = 33)

Damaged knee	Number of patients	Ratio (%)
Right knee	23	69.70
Left knee	10	30.30
Total	33	100.00

Accompanying lesions: As can be seen in Table VI, simple injuries were at the lowest rate-1/33 cases (accounting for 3.03%) and accompanied meniscus injuries got the highest rate 25/33 cases (accounting for 75.75%).

Table VI. Associated Knee Injuries of the Studied Patient Group (n = 33)

ACL rupture	Total
	Quantity	Ratio %
Pure	1	3.03
Meniscus	25	75.75
Posterior cruciate ligament (dilated)	1	3.03
Lateral ligament (dilated)	1	3.03
Posterior cruciate ligament (stretched) and meniscus	5	15.15
Total	33	100.00

As can be seen in Table VI, simple injuries were at the lowest rate-1/33 cases (accounting for 3.03%) and accompanied meniscus injuries got the highest rate 25/33 cases (accounting for 75.75%).

Time from trauma to laparoscopic surgery: Table VII shows the shortest duration of <1 month with 2/33 patients (accounting for 6.06%), the longest to be the period of 1-<2 months with 9/33 patients (accounting for 27.27%). The average time for surgery after injury was 3.5 months, of which 02 cases were operated 01 months earlier and 14 cases had surgery 6 months before surgery.

Table VII. Characteristics of Time of Surgery after Injury of the Studied Patient Group (n = 33)

No	Time	Number of patients	Ratio (%)
1	<1 month	2	6.06
2	1-<2 months	9	27.27
3	2-<3 months	3	9.09
4	3-<6 months	5	15.15
5	6-<1 year	7	21.21
6	≥ years	7	21.21
Total		33	100.00
Mean ± SD		3.48 ± 3.46
Min-Max		<1–12

Results of Assessing the Current Status of Partial ACL Rupture in Sports Players Examined at the Hospitals of An Sinh, Tan Son Nhat and Gia An through Clinical Tests

To solve the identified problem, the study employed methods of clinical medical examination and statistical mathematical methods for data synthesis and analysis. The software of Microsoft Office Excel and SPSS 22.0 were used for statistics and data analysis in this research.

To evaluate the current status of partial ACL rupture through clinical symptoms, the study applied the following tests: VAS scale (pain assessment), Lysholm scale (knee function assessment), anterior drawer test (evaluation of knee looseness before the knee folding position of 90 degrees), and Lachman test (evaluation of knee looseness before the knee folding position of 20–30 degrees).

VAS scale (assessment of functional pain symptoms): According to Table VIII, most cases had moderate functional pain symptoms (little pain) with an average value of 5.52 ± 1.60. Among them, the highest score was 3 with 13/33 patients (accounting for 39.39%). The lowest scores were 0, 1, and 2 (corresponding to no pain and little pain) with no patients.

Table VIII. Evaluation Results According to the Vas Scale of the Studied Patient Group (n = 33)

VAS scale	Number of patients	Ratio (%)
0	0	0.00
1	0	0.00
2	0	0.00
3	13	36.36
4	4	12.12
5	9	27.27
6	3	9.09
7	1	3.03
8	3	9.09
9	0	0.00
10	0	0.00
Total	33	100.00
Mean ± SD	5.52 ± 1.60
Min-Max	4.0–9.00

Lysholm scale (knee function assessment): The assessment results in Table IX show the highest proportion to be 65–83 points with 19/33 patients (accounting for 57.57%) and the lowest to be 95–100 points with no patients (accounting for 0.00%). While the average score was 66.48 ± 8.65, the highest was 85 and the lowest was 49. Thus, the vast majority of patients were rated for average knee joint function.

Table IX. Results of Knee Function Assessment of the Studied Patient Group (Lysholm Scale)

Lysholm score	Number of patients (n = 33)	Ratio (%)
<65 points	13	39.39
65–83 points	19	57.57
84–94 points	1	3.04
95–100 points	0	0.00
Total	33	100.00
Mean ± SD	66.48 ± 8.65
Min-Max	49.0–85.00

Anterior drawer test (evaluation of knee looseness before the knee folding position of 90 degrees): The results of the anterior drawer test shown in Table X indicate that the vast majority of patients (78.78%) were at looseness level 1 (+). The remaining 7 patients (–) needed a closer look. According to the evaluation standards, the looseness level was 1 (+) when the tibia moved forward >0 and <5 mm. When the tibia moves forward very little (1 mm or 2 mm), doctors are required to have experience and subtle feel to determine this rather small looseness which should be easy to be missed without attention. Therefore, to determine the status of knee joint laxity better, it is common to combine the anterior drawer test and the Lachman test.

Table X. Anterior Drawer Signs of the Studied Patient Group (n = 33)

Anterior drawer test	Number of patients	Ratio (%)
+++	0	0.00
++	0	0.00
+	26	78.78
–	7	21.22
Total	33	100.00

Lachman test (evaluation of knee looseness before the knee folding position of 20–30 degrees): The results of the Lachman sign assessment in Table XI reveal that all patients assessed at looseness level 1 (+) had 33 out of 33 patients (100%).

Table XI. Lachman’s Sign of the Studied Patient Group (n = 33)

Lachman test	Number of patients	Ratio (%)
+++	0	0.00
++	0	0.00
+	33	100.00
–	0	0.00
Total	33	100.00

Results of Assessing the Current Status of Partial ACL Rupture in Sports Players Examined at the Hospitals of An Sinh, Tan Son Nhat and Gia An through Paraclinical Tests

The study used the paraclinical medical examination method through patients’ MRI scan results which showed that the vast majority of patients had partial ACL rupture at level 1 or level 2, not at level 3. This was also consistent with the sample’s Lysholm index of mean knee joint function. MRI images (Fig. 1) showed that the fibrous tissue structure had a partial fracture lesion, but the axis and tension of the remaining ACL were still visible. This was the advantage that helped regenerate injured tissue on the foundation of the partially healthy one and offered a hinge and orientation for the development of the damaged ACL tissue.

Fig. 1. MRI results of the patient’s current condition: (1) Location of normal ACL section; (2) Location of torn ACL section.

Conclusion

Survey Results of General Characteristics and Lesion Characteristics of Partial ACL Rupture Injuries in Sports Players Examined at Hospitals of An Sinh, Tan Son Nhat and Gia An

General characteristics: In terms of gender, female patients in 19/33 cases accounted for a higher proportion than men (accounting for 57.58%). In terms of age, the age group of 21–40 accounted for a very high rate with 23/33 cases (accounting for 69.69%). Regarding the sport participated by the studied group of patients, there were 05 sports including Running, Soccer, Badminton, Gym and Aerobic among which Running took the highest proportion 57. 58% and Soccer followed accounting for over 27. 27%.

Lesion characteristics: The vast majority of injuries were non-collision-induced with 28/33 cases (accounting for 84.85%). The knee with 70% damage was the right knee. Most of the patients had comorbid lesions in which meniscus damage accounted for the highest rate with 25/33 cases (75.75%). The time from injury to surgery accounted for the largest proportion of 1 to less than 2 months with 9/33 patients (27.27%). The average time spent in post-traumatic surgery was 3.5 months, of which 2 cases were operated 1 month early and 14 cases were operated 6 months after injury.

Results of Assessing the Current Status of Partial ACL Rupture in Sports Players Examined at Hospitals of An Sinh, Tan Son Nhat and Gia An through Clinical Tests

VAS scale (assessment of functional pain symptoms): Most cases had moderate functional pain symptoms (little pain) with an average value of 5.52 ± 1.60 of which the highest score was 3 with 13/33 patients (accounting for 39.39%). The lowest scores included 0, 1, and 2 (corresponding to no pain and little pain) with no patients.

Lysholm scale (assessment of knee function): The highest proportion of patients with 65–83 points included 19/33 patients (accounting for 57.57%); the lowest rate was of 95–100 points with no patients (accounting for 0.00%). The average was 66.48 ± 8.65. Despite being rated for average knee joint function, this value was at the beginning of the average and close to the end value of the poor level. Therefore, this was a sign that knee function was in a warning state that required early intervention.

Anterior drawer test (assessment of the knee joint’s looseness before the knee was in the 90-degree position): 7/33 patients (21.22%) patients (−), 26/33 patients (78.78%) patients with looseness level 1 (+). As a result, there were 7/33 patients (accounting for 21.22%) were at looseness level (−), and 26/33 patients (accounting for 78.78%) were at looseness level 1 (+).

Lachman test (assessment of looseness of the knee joint before the knee is in a 20–30 degree folded position): There were 33/33 cases of patients (accounting for 100%) at looseness level 1 (+).

Results of Assessing the Current Status of Partial ACL Rupture in Sports Players Examined at the Hospitals of An Sinh, Tan Son Nhat and Gia An through Clinical Tests

MRI results of all patients’ knee joints clearly showed that the tissue structure of the ACL had a partial tear lesion but the axis and tension of the remaining part were still very pronounced.

Hence, both clinical and paraclinical evidence clearly showed that the current status of the partial ACL rupture significantly affected the patients’ knee function. However, functional signs such as pain level were not too large (only average) making the patients easy to get subjective. If not treated promptly, the ACL could be completely ruptured. Therefore, it is necessary to pay attention to ACL screening to avoid missing lesions. Furthermore, the remaining part of ACL will be a good foundation for the support and orientation of collagen fiber proliferation if treated appropriately. As a result, it is necessary to have early intervention measures for knee function improvement and restoration to help patients return to normal sports activities soon.

Limitations

The number of subjects in this study is quite limited (n = 33). The scope of the study was only surveyed at 2 hospitals (An Sinh, Tan Son Nhat and Gia An, Ho Chi Minh City). Therefore, it is necessary to expand research to have more objective results.