The anterior cruciate ligament (ACL) rupture is relatively uncommon among tennis players. A study conducted in Grenoble found only 13 cases of ACL rupture in a total of 272 acute tennis injuries seen in an accident and emergency department over a period of 10 years. Nevertheless, this injury is still very interesting to study in more detail. Our study regrouped 30 cases of ACL rupture, with the aim of identifying the mechanism of the lesion and the factors most likely to lead to ligament rupture. We also sought to determine the percentage of players treated with operative reconstruction of the ACL, and to establish whether a return to the level of play prior to the injury was possible with or without intervention. In general, as for all non-contact pivot sports, the trauma mechanism for the ACL rupture in tennis consists of an internal rotational force of the segment of the leg below the femur, with the knee close to extension. The classical situation in which this occurs is when the player is wrong-footed during play, wants to react, and tries to change direction aggressively while the foot is blocked on the ground, or during a slide on clay. Sometimes the mechanism is one of a forced hyperextension of the leg, for example after a jump smash. There are several clinical symptoms that indicate an ACL tear during tennis play. They include severe pain, immediate swelling of the knee, indicating hemarthros, or signs of instability with when walking on an uneven surface. Diagnosis depends primarily on the Lachman test, which should be performed as soon as possible after the injury. This test is designed to reveal signs of a posterior-anterior drawer and is conducted with the subject lying supine and the knee between 10-25 degrees of flexion. Our study, performed retrospectively from the dossier and completed by a telephone questionnaire by the same investigator, enabled us to analyse 31 cases of ACL rupture during tennis, with a minimum recovery period of 5 months. The study produced the following outcomes: The patients were 11 females and 20 males aged 16-49 years (mean 33 years), with injuries to 15 right knees and 16 left knees. Eight players had suffered other knee injuries prior to the ACL rupture (six distorsions, one medial meniscus lesion and one case of chondropathy). The level of play was variable and could be sub-divided into five categories, ranging from beginners to world class players, and 15 competition players (1st, 2nd and 3rd category). In 25 of 30 cases, the injury occurred on a hard court or synthetic surface. The situations during play in which the injury occurred were: recovery (seven cases), five times during the split step, seven times when the players were wrong-footed, four times when they were playing reflex volleys at the net, twice when receiving a smash, twice when being blocked during a slide, and four other less common situations. The trauma mechanism, therefore, is primarily blocking of the foot in internal rotation (19 times), but also in external rotation (9 times), with moderate flexion of the knee. In three situations, the knee was completely extended. In 17 cases, diagnosis of a rupture of the ACL, made clinically and by imaging, revealed associated lesions such as a medial meniscus (seven times), lateral collateral ligament (six times) or both lesions (four times). Surgery was performed in 19 of the 31 cases. The average delay before return to play was 7.2 months (3 days to 5 years). In 11 of 17 cases in the group treated with surgery, there was an associated lesion along with the ruptured ACL. Twenty-four of the players returned to tennis, with an average delay of 4.8 months (two to 12 months) after conservative treatment, and of 9.3 months (two to 18 months) after surgical treatment. Seven players did not resume play, although 3 tried (with a delay of 5 to 7 months after the operation). The remaining four continued other sports such as skiing, but not tennis. The level of post-recovery play, with an average follow-up of 58.5 months, was considered the same in 16 cases, better in four cases, and less in four cases. Analysis of our series does not show any significant difference between males and females, except for a higher percentage of operations among elite male tennis players. The court surface, whether hard or synthetic, is a risk factor. Analysis of the playing situations confirms that there are several high-risk situations that occur during a game of tennis. The type of treatment chosen does not appear to be a determining factor for complete recovery. The reason for quitting tennis is more often a lack of motivation, which is seen more often among the beginners and recreational players. In this series, the recovery period after operative treatment was longer (12 months), but surgery also leads to better stability of the knee in the long term and a quasi-certainty of a non-limited athletic future. The actual evolution of tennis played on the more or less aggressive surfaces requires increasing strength and speed in the sport, multiplying the risk of a rupture of the ACL. This study thus encourages us to better prepare our players, especially those of elite level, and to have a prevention programme geared towards a better control of the stabilising muscles of the knee.
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