405 acl presentation
Transcript of 405 acl presentation
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Randi M. HaupertPED 488
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“Anterior CruciateLigament”
1 of 4 major ligaments in the knee
Primary function is stabilization
Prevents extreme motion within the knee
http://www.orthoinfo.org/topic.cfm?topic=A00549
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200,000 annual injuries
½ result in ACL reconstruction surgery
50% occur in correlation with meniscus, articular cartilage, or ligament damage
Able to perform DTL without a properly functioning ACL
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Sports – Related Injury Motor Vehicle Accidents Falls Work – Related Injury
ACL TEARS OCCUR MOST FREQUENTLY WHEN PIVOTION OR
LANDING STRAIGHT LEGGED FROM A JUMP
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Hyperextension: Over Straightening
More than 10° beyond normal extension
Skiing, volleyball, basketball, soccer, football
Pivoting (Inward Rotation of lower leg) : Plant and twist combination
Football, tennis, basketball, soccer
Other common sports
Wrestling, gymnastics, martial arts, running
• 80% “Non Contact” Injuries • Female athletes are at higher risk
•Most frequently opt for surgery
•Tom Brady, Tiger Woods
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Position of the knee at time of injury
Direction of blow
Force of blow
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Knee usually gives-out from underneath
“Pop” in the knee Pain and Swelling Discomfort while walking Reduced range of motion Physician Examination Instability of the knee
▪ Lachman Test
MRI Pain and swelling can
reduce within a couple weeks
http://www.google.com/imgres?imgurl=http://factotem.org/library/images/Knee-MRI-and-Xray-images/f5-MRI-fully-torn-ACL-side-view.jpg&imgrefurl=http://factotem.org/library/database/Knee-Articles/Knee-MRI-and-Xray-images.shtml&usg=__dPwX0fIVW5MhIkMdO3EtWxCmbe0=&h=496&w=372&sz=27&hl=en&start=0&sig2=ffm3jrvL9B96qowUXtcQiA&zoom=1&tbnid=gfK5_AwRSMV92M:&tbnh=152&tbnw=114&ei=Ff79TLitJ4a8lQef0Z2fCA&prev=/images%3Fq%3Dmri%2Bof%2Ba%2Btorn%2Bacl%26hl%3Den%26sa%3DG%26biw%3D1362%26bih%3D533%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=541&vpy=156&dur=203&hovh=259&hovw=194&tx=106&ty=129&oei=Ff79TLitJ4a8lQef0Z2fCA&page=1&ndsp=15&ved=1t:429,r:3,s:0
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Knee flexed 30° Pull tibia to assess anterior range of
motion
Positive: Increased forward ROM
http://www.youtube.com/watch?v=dH_jnTy1rNk&list=PL09D0DFA4E90D92B7&ind
ex=51&playnext=3
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Not all ACL tears require surgery
“Do you routinely perform activities that normally require a functional ACL?”
“Is there knee instability?”
If ACL is not completely torn
Sedentary lifestyle or light manual work load
Growth plates
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Physical Therapy and Rehabilitation
Very important
▪ Restores motion
▪ Builds up strength
▪ Improves stability of joint
▪ Learn techniques to keep from reinjuring
Individualized progression
Hinged knee brace
Many experience second injury
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ACL Reconstruction
Tendon or ligament from patella or hamstrings
Standard treatment for young, active population
Patellar tendon graft Hamstrings graft Allograft
• 90% have no complications post – op• Concern with children: Can disrupt growth and
development
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Jog at 4 months Road biking 4-5 months Run in a straight line at 5 months Agility drills with brace at 6-8
months Sport specific activities at 4-24
months
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Strengthen muscles surrounding ACL to reduce risk of re-injury
Maintain (or lose) weight
Reduces stress on knees and lower extremities
Keeps blood circulation to reduce risk of developing clots post - op
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Progressing too quickly (or slowly) during rehabilitation
Risk of re-injury Avoid twisting exercises
▪ Balancing exercises
▪ One leg weight bearing exercises
Avoid weight bearing lunges
Avoid elevation jumping exercises
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Sports Medicine Physician
Work with Olympic athletes
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http://www.ehealthmd.com/library/acltears/ACL_activities.html
www.orthoinfo.aaos.org/topic.cfm?topic=a00297
www.orthopedics.about.com/od/aclinjury/tp/acl.htm